DR. CARL J SHEALY MD
NPI 1891706917
Family Medicine in Lexington, SC

Q: What is Carl Shealy's NPI number?

The NPI number for Carl Shealy is 1891706917. It was assigned to this individual provider in the NPPES registry on August 11, 2006.

Q: What is Carl Shealy's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Carl Shealy was last updated on November 11, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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 August 11, 2006PECOS EnrolledAccepts Medicare Assignment

83.03/100

CMS Quality Rating

2006 AUGUSTA HWY, LEXINGTON, SC 29072(803) 785-4747(803) 785-4750 Get Directions Write a Review

NPPES record last updated: November 11, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 11, 2020, Oct 2, 2020, Jun 7, 2017 (3 updates tracked since 2017).

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About Dr. Carl J Shealy Md NPPES

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

DR. CARL J SHEALY MD (NPI 1891706917) is an individual family medicine provider in Lexington, South Carolina, licensed in South Carolina (14977) and active in the NPI registry since August 2006. He is enrolled in Medicare PECOS, is affiliated with Lexington Medical Center, and is a graduate of Medical University Of South Carolina College Of Medicine (1989).

NPPES Registry Identity

NPI1891706917

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameDR. CARL J SHEALYCredential: MD

Location Address2006 AUGUSTA HWYLexington, SC 29072-2208

Mailing AddressPo Box 6069West Columbia, SC 29171-6069

Phone(803) 785-4747

Fax(803) 785-4750

Sole ProprietorNo

Medical School CMSMedical University Of South Carolina College Of MedicineGraduated 1989

Enumeration DateAugust 11, 2006

Last NPPES UpdateNovember 11, 20203 updates tracked since enumeration

NPPES CertifiedNovember 11, 2020

✔ NPI 1891706917 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in SC · 14977

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

2006 AUGUSTA HWY, Lexington, SC 29072

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Other Identifiers 1

Medicaid149770SC

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter of North Carolina, BlueCross BlueShield of South Carolina and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Carl J Shealy Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7618019605

PECOS Enrollment IDI20100129000146

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 24

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

990 services451 patients

Insertion of needle into vein for collection of blood sample 36415

This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.

450 services308 patients

Automated urinalysis test 81003

An automated urinalysis test is a routine examination that checks your urine for various substances. It can help identify potential health issues such as kidney problems or diabetes. The test uses a machine to analyze a small urine sample, providing quick and accurate results.

360 services277 patients

Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit G0438

An annual wellness visit is a yearly appointment with your doctor to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's an opportunity to discuss your health status and goals and get a plan tailored for you.

226 services226 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

86 services72 patients

Injection, ketorolac tromethamine, per 15 mg J1885

Ketorolac tromethamine is a medication administered through injection, often used to manage moderate to severe pain. Each 15 mg dose helps to reduce hormones causing inflammation and pain in the body. It is not recommended for long-term use.

80 services19 patients

Urine microalbumin (protein) analysis 82044

Urine microalbumin analysis is a test that measures the amount of a protein called albumin in your urine. This protein is usually present in very small amounts, but higher levels can indicate kidney issues. The test is non-invasive and involves a simple urine sample.

62 services55 patients

Creatinine level to test for kidney function or muscle injury 82570

A creatinine level test measures the amount of creatinine in your blood. This substance is a waste product from normal muscle use. Higher levels can indicate possible kidney dysfunction or muscle injury. This test helps monitor kidney health.

62 services55 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

51 services51 patients

Detection test by multiplex amplified probe technique for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (covid-19), influenza virus types a and b, and respiratory syncytial virus 87637

This test identifies if you have COVID-19, influenza A or B, or respiratory syncytial virus. It uses a multiplex amplified probe technique, which amplifies and detects specific genetic material of the viruses, helping in accurate diagnosis.

41 services39 patients

Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and G0180

This is a service where a doctor or authorized practitioner certifies that you require Medicare-covered home health services. They will communicate with the home health agency and review reports on your health status to ensure you receive appropriate care. This does not involve an in-person visit.

40 services36 patients

Administration of influenza virus vaccine G0008

The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.

34 services34 patients

Influenza vaccine split virus, preservative free 90662

The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.

33 services33 patients

Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report 93000

An electrocardiogram (ECG) is a non-invasive test that records your heart's electrical activity. Using 12 leads attached to your body, it captures data to help identify heart conditions. A doctor interprets the results and provides a report.

31 services31 patients

Administration of pneumococcal vaccine G0009

The pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.

24 services24 patients

Hemoglobin a1c level 83036

Hemoglobin A1c (HbA1c) is a test that measures your average blood sugar level over the past 2-3 months. It's used to monitor how well diabetes is being controlled. High levels may indicate that your diabetes treatment plan needs adjustment.

23 services21 patients

Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use 90677

The Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.

22 services22 patients

X-ray of chest, 2 views 71046

A chest X-ray, 2 views, is a quick, painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. Two different angles are used to get a comprehensive view. This helps in diagnosing conditions like pneumonia, heart problems, or lung cancer.

21 services21 patients

Administration of vaccine 90471

Administering a vaccine involves injecting a small, safe piece of a virus or bacteria into your body. This triggers your immune system to recognize and fight off the disease in the future. It's a vital tool in preventing serious illnesses and maintaining public health.

18 services18 patients

Removal of impacted ear wax by washing 69209

Impacted ear wax removal by washing, also known as ear irrigation, involves using a pressurized flow of water to break up and dislodge the ear wax. This safe procedure helps restore normal hearing and relieve discomfort caused by the blockage.

15 services15 patients

Transitional care management services for problem of at least moderate complexity 99495

Transitional care management services focus on coordinating and managing your care after you leave the hospital. For moderate complexity problems, this involves managing your medications, arranging further treatments, and ensuring you have the necessary follow-ups.

14 services13 patients

X-ray of upper spine, 4-5 views 72050

An X-ray of the upper spine with 4-5 views is a non-invasive imaging test. It uses radiation to capture detailed images of the bones and structures in your neck and upper back. This procedure helps identify issues like fractures, infections, or deformities.

11 services11 patients

X-ray of lower and sacral spine, 2-3 views 72100

An X-ray of the lower and sacral spine involves capturing images of your lower back area, including the tailbone. This procedure helps in identifying problems like fractures, infections, or deformities. 2-3 different angle views provide a comprehensive picture.

11 services11 patients

Diphtheria, tetanus, and acellular pertussis vaccine (7 years or older) 90715

The Diphtheria, Tetanus, and Acellular Pertussis vaccine, also known as Tdap, is an immunization given to protect against three serious diseases. It's recommended for those aged 7 or older. The vaccine stimulates your body to build defenses against these infections, promoting overall health.

11 services11 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Lexington Medical Center

Acute Care Hospitals · West Columbia, SC

3/5 CMS rating

OwnershipGovernment - Hospital District or Authority

CMS Certification Number420073

Location2720 Sunset BlvdWest Columbia, SC 29169 · Lexington County

Emergency services Birthing friendly

Prisma Health Baptist

Acute Care Hospitals · Columbia, SC

4/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number420086

Location1330 Taylor At Marion StColumbia, SC 29220 · Richland County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 29072 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

$95.12 typical visit price

range $16.96 – $133.52

Typical copayment $23.78 (range $4.24 – $33.38)

Most-billed visit code 99214

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

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

83.03/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

80.45

Promoting Interoperability

Improvement Activities

Cost

72.17

Referred Medical Equipment & Supplies CMS DME claims 4

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253

DME-Other DME · category DE017N

15 suppliers38 claims99 services$5.67 avg. paid by Medicare

Lancets, per box of 100 A4259

DME-Medical/Surgical Supplies · category DA000N

7 suppliers13 claims22 services$1.02 avg. paid by Medicare

Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate E1390

DME-Oxygen and Supplies · category DC002N

2 suppliers11 claims11 services$58.90 avg. paid by Medicare

Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553

DME-Other DME · category DE017N

4 suppliers64 claims64 services$181.98 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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Other Providers at the Same Location NPPES 12

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

DR. CLARENCE E COKER III MD

Family Medicine