Cherokee Community Care, LLC
Organization Active NPI Family Medicine Physician · Gaffney, SC
NPI 1003462151 · NPPES record last updated Oct 30, 2023
Key facts
- NPI
- 1003462151
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- CHEROKEE COMMUNITY CARE, LLC
- Practice address
- 1307 N Logan St
Gaffney, SC 29341-2026 - Phone
- (864) 488-1333
- NPI assigned
- Aug 14, 2019
- Organization subpart
- No
Authorized official
- Name
- Lena Connie Stuart
- Title
- Owner/Office Manager
- Phone
- (864) 488-1333
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Practitioners 4
-
Amanda Falls Broome, PA-C
-
Timothy Stuart, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SC
Rural health clinic certification: CCN 428948
- Legal name
- CHEROKEE COMMUNITY CARE, LLC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Nov 20, 2001
- Last certification
- Feb 2, 2023
- Ownership / control type
- 1A
- Organization structure
- LLC · Proprietary
- Incorporated
- in SC
- Enrollment address
- 1307 N Logan St
Gaffney, SC 29341-2026
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Lena Stuart |
5% Or Greater Direct Ownership Interest |
Sep 16, 2019 | 100% |
| W-2 Managing Employee |
Sep 16, 2019 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191016000683 | SC | Part a Provider - Rural Health Clinic | 6406187855 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Gaffney, SC |
| O20191115001042 | SC | Part B Supplier - Clinic/Group Practice | 6406187855 |
Receives reassigned benefits from 4 practitioners Practice locations: Gaffney, SC |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
1307 N Logan St
Gaffney, SC 29341-2026
Mailing address
1307 N Logan St
Gaffney, SC 29341-2026
Phone (864) 488-1333
Other providers in Gaffney, SC
- Zack Chakra
- Emily Ivey Chamberlain
- Michelle Chau
- Cherokee Chiropractic Clinic
- Cherokee Co. Schools
- Cherokee Community Care, LLC
- Cherokee County Commission on Alcohol and Drug Abuse
- Cherokee County DSN Board
- Cherokee County School District
- Cherokee General Dentistry
All providers in Gaffney, SC · Family Medicine Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.