NPIMap

Organization Active NPI

Eau Claire Cooperative Health Center ,Inc.

Doing business as Advantage Eye Care

  • Federally Qualified Health Center (FQHC)
  • Columbia, SC
National Provider Identifier
1063159267
Registry record updated May 18, 2022
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
Advantage Eye Care
Practice address
115 Atrium Way Ste 120
Columbia, SC 29223-6382
Phone
(803) 875-8020
Fax
(803) 626-0742
NPI assigned
May 18, 2022
Last updated
May 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2022

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

Authorized official

Name
Delgado Cantave
Title
Ceo
Phone
(803) 733-5969

Specialties & licenses 1

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

Addresses

Primary practice location

115 Atrium Way Ste 120
Columbia, SC 29223-6382

Mailing address

169 Laurelhurst Ave
Columbia, SC 29210-3825
Phone (803) 733-5969

Other names 1

  • Advantage Eye Care 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…
O20220630001243 SC Part A Provider - Federally Qualified Health Center (FQHC) 3274434220 Practice locations: Columbia, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063159267. Details of each certification follow.

Federally qualified health center certification: CCN 871038

Legal name
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Doing business as
ADVANTAGE EYE CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 1, 2022
Last certification
Jun 1, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
115 Atrium Way
Ste 120
Columbia, SC 29223-6382

Other NPIs on the same Medicare enrollment 23

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

View all 23

National Provider Directory

National Provider Directory
Tax ID family
Brookland-Cayce Pediatric44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

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

View all 43

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Hasan Ross-El Individual Corporate DirectorVice Chair Apr 1, 2019
Bernice Kennedy Individual Corporate Director Mar 1, 2014
Craig Currey Individual Corporate DirectorTreasurer Jul 1, 2014
Eau Claire Cooperative Health Center, Inc. Organization, Columbia, SC Corporation 5% Or Greater Direct Ownership Interest Jun 1, 2022
Ashley Jackson Individual Corporate Director Jun 1, 2013
Deborah Depaoli Individual Corporate DirectorSecretary Jun 1, 2017
Dean Slade Individual Corporate Director Jul 1, 2017
Karena S White Individual Corporate DirectorCfo Jun 1, 2021
W-2 Managing EmployeeCfo Jun 1, 2021
Junior Delgado Cantave Individual Corporate DirectorCeo Jan 1, 2019
W-2 Managing EmployeeCeo Jan 1, 2019
Julia Easterlin Individual Corporate Director Jul 1, 2013
Julie Smithwick Individual Corporate Director Sep 1, 2016
Glenn Stalions Individual Corporate Director May 1, 2016
Generett Dingle Individual Corporate Director Feb 1, 2018
Elaine Eskew Individual Corporate Director Jun 1, 2019
Gregory Torrales Individual Corporate DirectorBoard Chair Mar 1, 2014
Rafael Gonzalez Individual Corporate Director Dec 1, 2021

All facility ownership & control disclosures 13

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

Facilities with the same owner 13

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1652832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652832000000",
    "number": "1063159267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 LAURELHURST AVE",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292103825",
            "telephone_number": "803-733-5969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 ATRIUM WAY STE 120",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292236382",
            "telephone_number": "803-875-8020",
            "fax_number": "803-626-0742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAU CLAIRE COOPERATIVE HEALTH CENTER ,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-18",
        "last_updated": "2022-05-18",
        "certification_date": "2022-04-21",
        "status": "A",
        "authorized_official_last_name": "CANTAVE",
        "authorized_official_first_name": "DELGADO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-733-5969"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advantage Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.