NPIMap

Organization Active NPI

McLeod Health Cheraw

Doing business as McLeod Family Medicine - Darlington

  • Rural Health Clinic/Center
  • Darlington, SC
National Provider Identifier
1003410903
Registry record updated Feb 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MCLEOD HEALTH CHERAW
Doing business as
McLeod Family Medicine - Darlington
Practice address
701 Cashua Ferry Rd
Darlington, SC 29532-8488
Phone
(843) 398-8500
NPI assigned
Nov 23, 2020
Last updated
Feb 17, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
MCLEOD HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 17, 2021

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

Authorized official

Name
Mr. Samuel Fulton Ervin III
Title
Sr. VP and Cfo
Phone
(843) 777-2910

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

701 Cashua Ferry Rd
Darlington, SC 29532-8488

Mailing address

701 Cashua Ferry Rd
Darlington, SC 29532-8488
Phone (843) 398-8500

Other identifiers 1

IdentifierTypeStateIssuer
42-3416OtherSCMEDICARE

Other names 1

  • McLeod Family Medicine - Darlington Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20151218002079 SC Part B Supplier - Clinic/Group Practice 7911228259 Receives reassigned benefits from 275 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bennettsville, SC; Mullins, SC; Darlington, SC; Cheraw, SC
O20210114002642 SC Part A Provider - Rural Health Clinic 7911228259 Practice locations: Darlington, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003410903. Details of each certification follow.

Rural health clinic certification: CCN 423416

Legal name
MCLEOD HEALTH CHERAW
Doing business as
MCLEOD FAMILY MEDICINE-DARLINGTON
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 20, 1996
Last certification
Nov 23, 2020
Ownership / control type
1B
Organization structure
CorporationNon-profit
Incorporated
Apr 3, 2015 in SC
Enrollment address
701 Cashua Ferry Rd
Darlington, SC 29532-8488
Related CCNs
420107

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
McLeod Health Cheraw4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

318 2nd St
Cheraw, SC 29520
Phone (843) 537-5563

114 E McGregor St
Pageland, SC 29728
Phone (843) 320-5212

Ownership & related parties

All disclosed owners & managing parties 26

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

NameRoleSinceShare
Willie E Boyd Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Vinod K Jona Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Steven R Ross Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Frances S Jones Individual Corporate OfficerBoard of Directors Jan 1, 2021
Ashley Brady Individual Corporate OfficerBoard of Trustees Jan 1, 2021
William N Boulware Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Allie E Brooks Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Benjamin T Zeigler Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Ronald M Fowler Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Dudley B. Harrington Individual Corporate OfficerVP of Business Operations Jan 1, 2021
Jeannette Glenn Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Samuel F Ervin Individual Corporate OfficerSr Vice President and Cfo Jan 1, 2021
Bren Lowe Individual W-2 Managing EmployeeVP, Administrator Cheraw Jan 1, 2021
Raymond Clark Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Hugh S Blair Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Mary Anderson Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Tracy Ray Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Tarek M Bishara Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Beverly Hazelwood Individual Corporate OfficerBoard of Trustees Jan 1, 2021
McLeod Health Cheraw Organization, Cheraw, SC Corporation Operational/Managerial Control Jan 1, 2021 100%
Frank V Boulineau Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Michael R Rose Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Patrick Kerry Denton Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Frank J Brand Individual Corporate OfficerBoard of Trustees Jan 1, 2021
James C Smith Individual Corporate OfficerBoard of Trustees Jan 1, 2021
John R Braddy Individual Corporate OfficerBoard of Trustees Jan 1, 2021

Owners & managing parties with NPI records 12

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Change-of-ownership history 1

DateEventCounterparty
Jan 1, 2021 Change of OwnershipThis provider was the buyer McLeod Family Medicine DarlingtonCCN 423416, SC, NPI 1376515197

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 275

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 275

NPI Registry JSON

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

{
    "created_epoch": "1606089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613520000000",
    "number": "1003410903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 CASHUA FERRY RD",
            "city": "DARLINGTON",
            "state": "SC",
            "postal_code": "295328488",
            "telephone_number": "843-398-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 CASHUA FERRY RD",
            "city": "DARLINGTON",
            "state": "SC",
            "postal_code": "295328488",
            "telephone_number": "843-398-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLEOD HEALTH CHERAW",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCLEOD HEALTH",
        "enumeration_date": "2020-11-23",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A",
        "authorized_official_last_name": "ERVIN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "FULTON",
        "authorized_official_title_or_position": "SR. VP AND CFO",
        "authorized_official_telephone_number": "843-777-2910",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "42-3416",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McLeod Family Medicine - Darlington",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "McLeod Family Medicine - Darlington",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Darlington, SC

Sources for this page

Verify at the official NPI Registry.