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DOMINIQUE BULTSMA MD PC
NPI 1336932870
Internal Medicine in Charleston, SC

Active since May 27, 2025
2142 EXECUTIVE HALL RD, CHARLESTON, SC 29407(843) 729-6316 Get Directions Write a Review

NPPES record last updated: June 26, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Dominique Bultsma Md Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DOMINIQUE BULTSMA MD PC (NPI 1336932870) is a healthcare organization registered as an internal medicine in Charleston, South Carolina and active in the NPI registry since May 2025. The organization lists Dominique Bultsma, Owner, as its authorized official.

NPPES Registry Identity

NPI1336932870
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameDOMINIQUE BULTSMA MD PC
Location Address2142 EXECUTIVE HALL RDCharleston, SC 29407-8713
Mailing Address2142 Executive Hall RdCharleston, SC 29407-8713 · (843) 729-6316
Phone(843) 729-6316
Organization SubpartNo
Authorized OfficialDominique BultsmaOwner · (843) 412-9012
Enumeration DateMay 27, 2025
Last NPPES UpdateJune 26, 2026
NPPES CertifiedJune 26, 2026
✔ NPI 1336932870 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
2142 EXECUTIVE HALL RD, Charleston, SC 29407
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dominique Bultsma Md Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Dominique Bultsma MD PC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Dominique Bultsma, MD
Internal Medicine
NPI 1033733704
345 FRESHFIELDS DR STE J101
Johns Island, SC 29455
(843) 768-4800
✔ PECOS✔ Accepts Medicare15 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dominique Bultsma MD PC's NPI number?

The NPI number for Dominique Bultsma MD PC is 1336932870. It was assigned to this organization in the NPPES registry on May 27, 2025.

Where is Dominique Bultsma MD PC located?

Dominique Bultsma MD PC is located at 2142 Executive Hall Rd, Charleston, SC 29407. The listed phone number is (843) 729-6316.

What is Dominique Bultsma MD PC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Dominique Bultsma MD PC enrolled in Medicare?

Yes. Dominique Bultsma MD PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Dominique Bultsma MD PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Dominique Bultsma MD PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Dominique Bultsma MD PC was last updated on June 26, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.