NICHOLAS THOMAS SISOFO IV PA
NPI 1700544103
Physician Assistant in Summerville, SC

Q: What is Nicholas Sisofo's NPI number?

The NPI number for Nicholas Sisofo is 1700544103. It was assigned to this individual provider in the NPPES registry on December 2, 2021.

Q: What is Nicholas Sisofo's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: Is Nicholas Sisofo enrolled in Medicare?

No. Nicholas Sisofo has opted out of Medicare through September 5, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

Q: When was this NPI record last updated?

The NPPES record for Nicholas Sisofo was last updated on April 30, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.

Active since December 02, 2021Opted out of Medicare · through Sep 5, 2026

709 OLD TROLLEY RD, SUMMERVILLE, SC 29485(843) 900-6767(843) 285-5916 Get Directions Write a Review

NPPES record last updated: April 30, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 30, 2024, Jul 26, 2022, Dec 2, 2021 (3 updates tracked since 2021).

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About Nicholas Thomas Sisofo Iv Pa NPPES

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

NICHOLAS THOMAS SISOFO IV PA (NPI 1700544103) is an individual physician assistant in Summerville, South Carolina and active in the NPI registry since December 2021. He has opted out of Medicare through September 5, 2026 and remains eligible to order and refer.

NPPES Registry Identity

NPI1700544103

Entity TypeIndividualMale

Primary Taxonomy363A00000X

Provider Legal NameNICHOLAS THOMAS SISOFO IVCredential: PA

Location Address709 OLD TROLLEY RDSummerville, SC 29485-5203

Mailing Address709 Old Trolley RdSummerville, SC 29485-5203

Phone(843) 900-6767

Fax(843) 285-5916

Sole ProprietorNo

Enumeration DateDecember 2, 2021

Last NPPES UpdateApril 30, 20243 updates tracked since enumeration

NPPES CertifiedApril 30, 2024

✔ NPI 1700544103 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

709 OLD TROLLEY RD, Summerville, SC 29485

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BlueCross BlueShield of South Carolina, First Choice Next, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

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Opted out of Medicare

Nicholas Thomas Sisofo Iv Pa has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from September 5, 2024 through September 5, 2026.

Opt-Out Effective DateSeptember 5, 2024

Opt-Out In Effect ThroughSeptember 5, 2026Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 29485 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$83.18 typical visit price

range $53.57 – $163.84

Typical copayment $20.79 (range $13.39 – $40.96)

Most-billed visit code 99203

Established Patient

$67.12 typical visit price

range $16.96 – $133.52

Typical copayment $16.78 (range $4.24 – $33.38)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BRIAN D MUSOLF LPC

Counselor (Professional)