Health Care Partners of South Carolina, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Conway, SC
NPI 1043395346 · NPPES record last updated Dec 22, 2023
Key facts
- NPI
- 1043395346
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 20075227 (SC)
- Legal business name
- HEALTH CARE PARTNERS OF SOUTH CAROLINA, INC.
- Practice address
- 1608 N. Main St
Conway, SC 29526-3572 - Phone
- (843) 248-4700
- NPI assigned
- Oct 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Santina Mayo
- Title
- Ceo
- Phone
- (843) 488-6364
Owners & managing parties with NPI records 1
-
Jeanne Laird Halyard, M.D.
Other NPIs on the same Medicare enrollment 7
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 15
Practitioners 41
-
Edith Bostic, APRN
-
Keith Allen Burke, D.O.
-
Stephanie Durso, LCSW LISW-CP
-
Jeanne Laird Halyard, M.D.
-
John Vincent Maylock, M.D.
-
Cynthia Grady McCall, M.D.
-
Kristen Mottey, LISW-CP
-
Lindsey Rose Nelson, LISW-CP
-
Jennifer Sue Roy, APRN
-
Amanda Jean Ruby, NP
-
Kristin White, OD
-
Linda Wilds, FNP
-
Paige Johnson Young, FNP-C
-
Kevin Cornwell, O.D.
-
Karen Lynn Berrios, D.M.D.
-
Terry Carlyle Dixon, M.D., PH.D.
-
Judy G. Figueroa, APRN
-
Tama Harrell, LMSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SC
Federally qualified health center certification: CCN 421810
- Legal name
- HEALTH CARE PARTNERS OF SOUTH CAROLINA, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- May 1, 1992
- Last certification
- May 1, 1992
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 30, 1979 in SC
- Enrollment address
- 1608 Main St
Conway, SC 29526-3572
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Melody Chriswell |
Corporate Director | Jan 1, 2009 | |
| Darrell Jameson |
Corporate Director |
Jun 1, 2015 | |
| Michael Hemingway |
Corporate Director |
Mar 1, 2021 | |
| Catalina Krull |
Corporate Director | Jan 1, 2009 | |
| Jeanne L Halyard |
Corporate Officer |
Jan 1, 2009 | |
| Raquel Leslie-Benning |
Corporate Director |
Apr 1, 2018 | |
| Patricia Atkinson |
Corporate Director |
Jun 1, 2015 | |
| George Williams |
Corporate Director | Jan 1, 2009 | |
| Georgette Washington |
Corporate Director |
Feb 1, 2016 | |
| Robert Reel |
Corporate Officer |
Sep 1, 2019 | |
| W-2 Managing Employee |
Sep 1, 2019 | ||
| Latisha McClam |
Corporate Director |
Apr 1, 2018 | |
| Santina Mayo |
Corporate Officer |
Aug 1, 2023 | |
| Corporate Director |
Aug 1, 2023 | ||
| W-2 Managing Employee |
Aug 1, 2023 | ||
| Yvonne David |
Corporate Director |
Jan 3, 1997 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100318000064 | SC | Part B Supplier - Clinic/Group Practice | 3577668763 |
Receives reassigned benefits from 38 practitioners 7 other NPIs on this enrollment Practice locations: Conway, SC; Gresham, SC; Johnsonville, SC; Marion, SC |
| O20100603000598 | SC | Part a Provider - Federally Qualified Health Center (FQHC) | 3577668763 |
1 other NPI on this enrollment Practice locations: Conway, SC |
National Provider Directory
- Tax ID family
- Health Care Partners Pharmacy
Locations
1608 Main St
Conway, SC 29526
Phone (843) 488-6032
237 S Georgetown Hwy
Johnsonville, SC 29555
Phone (843) 386-2609
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 20075227 | SC | Yes |
Addresses
Primary practice location
1608 N. Main St
Conway, SC 29526-3572
Mailing address
1708 Oak St
Conway, SC 29526-3086
Phone (843) 248-4700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| FQC010 | Medicaid | SC |
Other providers in Conway, SC
- Richard Y Hayes
- Barbara Haynes
- Johanna Haynes
- Lori Ann Hayward
- HB Medical
- Health Care Partners of South Carolina, Inc.
- Health Care Partners of South Carolina, Inc.
- Health Care Partners of South Carolina, Inc.
- Health Care Partners of South Carolina, Inc.
- Health Care Partners of South Carolina, Inc.
All providers in Conway, SC · Federally Qualified Health Center (FQHC) 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 Dec 22, 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.