NPIMap

Organization Active NPI

Eau Claire Cooperative Health Center, Inc

Doing business as Cooperative Health Winnsboro

  • Federally Qualified Health Center (FQHC)
  • Winnsboro, SC
National Provider Identifier
1003113168
Registry record updated Aug 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC
Doing business as
Cooperative Health Winnsboro
Practice address
1136 Kincaid Bridge Rd
Ste. a
Winnsboro, SC 29180-7116
Phone
(803) 635-1052
Fax
(803) 712-9724
NPI assigned
Feb 24, 2011
Last updated
Aug 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly M Tilley
Title
Sr. Credentialing Specialist
Phone
(804) 306-1203

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1136 Kincaid Bridge Rd
Ste. a
Winnsboro, SC 29180-7116

Mailing address

PO Box 3788
Columbia, SC 29230-3788
Phone (803) 733-5969

Other identifiers 3

IdentifierTypeStateIssuer
FQC133MedicaidSC
CBP018MedicaidSC
FQC031MedicaidSC

Other names 1

  • Cooperative Health Winnsboro Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040114000335 SC Part B Supplier - Clinic/Group Practice 3274434220 Receives reassigned benefits from 153 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Columbia, SC; Eastover, SC; Hopkins, SC; Jenkinsville, SC; Leesville, SC; Little Mountain, SC; Newberry, SC; Pelion, SC…
O20120622000335 SC Part A Provider - Federally Qualified Health Center (FQHC) 3274434220 Practice locations: Winnsboro, SC

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1003113168. Details of each certification follow.

Federally qualified health center certification: CCN 421964

Legal name
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Doing business as
WINNSBORO PEDIATRICS & FAMILY PRACTICE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 22, 2012
Last certification
Jun 22, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 14, 1992 in SC
Enrollment address
1136 Kincaid Bridge Rd
Ste a
Winnsboro, SC 29180-0326

Federally qualified health center certification: CCN 421945

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
PALMETTO FAMILY PRIMARY HEALTH CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 1, 2011
Last certification
Sep 1, 2011
Ownership / control type
For profit – corporation
Facility address
1136 Kincaid Bridge Road
Winnsboro, SC 29180

Other NPIs on the same Medicare enrollment 23

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 23

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2293998Winnsboro Pediatrics and Family Practice1136 Kincaid Bridge Road, Winnsboro, SC 29180Provider-performed microscopyNov 16, 2027

National Provider Directory

National Provider Directory

Locations

12 Meadowlake Rd
Blair, SC 29015
Phone (803) 945-7595

1520 Laurel St
Columbia, SC 29201
Phone (803) 256-3400

3010 Farrow Rd
Ste 220
Columbia, SC 29203
Phone (803) 799-1264

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10781/brand/1/csg/1/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Karena S White Individual Corporate Officer Dec 21, 2020
W-2 Managing Employee Dec 21, 2020
Junior Delgado Cantave Individual Contracted Managing Employee Sep 28, 2016
Corporate Director Sep 28, 2016

All facility ownership & control disclosures 14

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Eau Claire Cooperative Health Center, Inc.Columbia, SC, CCN 421843 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2019
Eastover Family PracticeEastover, SC, CCN 421960 Federally qualified health center Operational/Managerial Control Jan 26, 2012
Pediatrics of NewberryNewberry, SC, CCN 421970 Federally qualified health center 5% Or Greater Direct Ownership Interest Jul 1, 2014
Waverly Women's Health & Internal MedicineBatesburg Leesville, SC, CCN 421974 Federally qualified health center 5% Or Greater Direct Ownership Interest Jun 1, 2010
Eau Claire PodiatryColumbia, SC, CCN 421968 Federally qualified health center 5% Or Greater Direct Ownership Interest Mar 7, 2022
Sterling Sharpe PediatricsSuite 1, SC, CCN 421972 Federally qualified health center 5% Or Greater Direct Ownership Interest Nov 4, 2014
Pelion Pediatrics Family & DentalPelion, SC, CCN 421977 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 19, 2012
Brookland Community PediatricsWest Columbia, SC, CCN 421978 Federally qualified health center 5% Or Greater Direct Ownership Interest Jul 1, 2010
Pediatrics of Batesburg-LeesburgBatesburg-Leesville, SC, CCN 421980 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 30, 2012
Eau Claire Walk-inColumbia, SC, CCN 421023 Federally qualified health center 5% Or Greater Direct Ownership Interest Mar 7, 2022
Five Points Behavioral Health at Hand Middle SchoolColumbia, SC, CCN 421064 Federally qualified health center Operational/Managerial Control Jan 1, 2016
Eau Claire Cooperative Health Center, Inc.Little Mountain, SC, CCN 421068 Federally qualified health center Operational/Managerial Control Jan 1, 2016
Columbia Community Family PracticeColumbia, SC, CCN 871035 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2016
Advantage Eye CareColumbia, SC, CCN 871038 Federally qualified health center 5% Or Greater Direct Ownership Interest Jun 1, 2022

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1298505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755129600000",
    "number": "1003113168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3788",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292303788",
            "telephone_number": "803-733-5969",
            "fax_number": "803-753-5591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1136 KINCAID BRIDGE RD",
            "address_2": "STE. A",
            "city": "WINNSBORO",
            "state": "SC",
            "postal_code": "291807116",
            "telephone_number": "803-635-1052",
            "fax_number": "803-712-9724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAU CLAIRE COOPERATIVE HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-24",
        "last_updated": "2025-08-14",
        "certification_date": "2025-08-14",
        "status": "A",
        "authorized_official_last_name": "TILLEY",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SR. CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "804-306-1203"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC133",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CBP018",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC031",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cooperative Health Winnsboro",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winnsboro, SC

Sources for this page

Verify at the official NPI Registry.