NPIMap

Organization Active NPI

McLeod Regional Medical Center of the Pee Dee, Inc.

Doing business as Hospice of the Pee Dee

  • Community Based Hospice Care Agency
  • Florence, SC
National Provider Identifier
1043289333
Registry record updated May 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC.
Doing business as
Hospice of the Pee Dee
Practice address
1203 East Cheves Street
Florence, SC 29506-2711
Phone
(843) 777-2564
Fax
(843) 777-5135
NPI assigned
Mar 17, 2006
Last updated
May 3, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
MCLEOD HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 3, 2016

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. Vice President and Cfo
Phone
(843) 777-2910

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X HPF003 SC
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

1203 East Cheves Street
Florence, SC 29506-2711

Mailing address

1203 East Cheves Street
Florence, SC 29506-2711
Phone (843) 777-2564

Other identifiers 1

IdentifierTypeStateIssuer
HSP009MedicaidSC

Other names 1

  • Hospice of the Pee Dee Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160413001594 SC Part A Provider - Hospice 7416851852 Practice locations: Cheraw, SC; Manning, SC; Loris, SC; Dillon, SC; Florence, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043289333. Details of each certification follow.

Hospice certification: CCN 421516

Legal name
MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE INC
Doing business as
HOSPICE OF THE PEE DEE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 9, 1993
Last certification
Nov 18, 2021
Ownership / control type
Other
Organization structure
CorporationNon-profit
Incorporated
Feb 5, 1930 in SC
Enrollment address
1203 East Cheves Street
Florence, SC 29506-2711

Other NPIs with the same Medicare PAC ID 6

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

Care Compare: Hospice

Medicare Care Compare
Listed as
McLeod HCS - Hospice of the Pee DeeCCN 421516 · All quality measures
Ownership
Other
Certified
Mar 9, 1993
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 28

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
Frances S Jones Individual Corporate OfficerBoard of Trustees 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
Virginia L Clyburn-Ipock Individual Corporate OfficerBoard of Trustees Jan 1, 2023
Jeannette Glenn Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Samuel F Ervin Individual Corporate OfficerSr VP and Cfo Nov 22, 2011
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
Donna Isgett Individual Corporate OfficerPresident & Cfo Mar 1, 2021
Tarek M Bishara Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Beverly Hazelwood Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Amy Fisher Individual Corporate OfficerBoard of Trustees Jan 1, 2023
McLeod Regional Medical Center of the Pee Dee Inc Organization, Florence, SC Non-profit 5% Or Greater Direct Ownership Interest Jul 3, 2003
Amit Vyankatesh Pande Individual Corporate OfficerBoard of Trustees Jan 1, 2023
Frank V Boulineau 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
Carl J Chelen Individual Corporate OfficerBoard of Trustees Jan 1, 2023
John R Braddy Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Crystal Joy Orphan Individual W-2 Managing EmployeeAdministrator of Hospice and Pallia Jan 17, 2022

Owners & managing parties with NPI records 13

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

View all 13

Practitioners & affiliated clinicians

Affiliated clinicians 15

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462233600000",
    "number": "1043289333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 EAST CHEVES STREET",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295062711",
            "telephone_number": "843-777-2564",
            "fax_number": "843-777-5135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 EAST CHEVES STREET",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295062711",
            "telephone_number": "843-777-2564",
            "fax_number": "843-777-5135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCLEOD HEALTH",
        "enumeration_date": "2006-03-17",
        "last_updated": "2016-05-03",
        "status": "A",
        "authorized_official_last_name": "ERVIN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "FULTON",
        "authorized_official_title_or_position": "SR. VICE PRESIDENT AND CFO",
        "authorized_official_telephone_number": "843-777-2910",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "SC",
            "license": "HPF003",
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP009",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hospice of the Pee Dee",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Florence, SC

Sources for this page

Verify at the official NPI Registry.