NPIMap

Organization Active NPI

Abbeville County Memorial Hospital

Doing business as Abbeville Area Medical Center

  • Critical Access Hospital
  • Abbeville, SC
National Provider Identifier
1063449361
Registry record updated Nov 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
HTL-098 Issued in SC
Legal business name
ABBEVILLE COUNTY MEMORIAL HOSPITAL
Doing business as
Abbeville Area Medical Center
Practice address
420 Thomson Cir
Abbeville, SC 29620
Phone
(864) 366-5011
Fax
(864) 366-3317
NPI assigned
Jun 26, 2006
Last updated
Nov 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2024

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

Authorized official

Name
Matthew Tolbert Logan
Title
President/ Ceo
Phone
(864) 725-4780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X HTL-098 SC Primary

Addresses

Primary practice location

420 Thomson Cir
Abbeville, SC 29620

Mailing address

PO Box 887
Abbeville, SC 29620-0887
Phone (864) 336-3279

Other identifiers 3

IdentifierTypeStateIssuer
142571MedicaidSC
400612MedicaidSC
252726MedicaidSC

Other names 1

  • Abbeville Area Medical Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL AthenaEHR Other

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031117000214 SC Part B Supplier - Clinic/Group Practice 7719891506 Receives reassigned benefits from 102 practitioners
7 other NPIs on this enrollment
Practice locations: Abbeville, SC; Due West, SC
O20080218000142 SC Part A Provider - Critical Access Hospital 7719891506 Receives reassigned benefits from 38 practitioners
1 other NPI on this enrollment
Practice locations: Abbeville, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063449361. Details of each certification follow.

Hospital certification: CCN 421301

Legal name
ABBEVILLE COUNTY MEMORIAL HOSPITAL
Doing business as
ABBEVILLE AREA MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Oct 1, 2004
Last certification
Apr 29, 2022
Beds
25
Ownership / control type
Other
Organization structure
OtherNon-profit
Incorporated
Mar 1, 1954 in SC
Enrollment address
420 Thomson Circle
Abbeville, SC 29620-5678
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 5

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Abbeville Area Medical CenterCCN 421301 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D0252634Abbeville Area Medical Center Laboratory420 Thomson Circle, Abbeville, SC 29620AccreditationFeb 8, 2027
42D0915640Abbeville Area Medical Center Laboratory420 Thomson Circle, Abbeville, SC 29620Certificate of waiverJun 3, 2028

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Matthew T Logan Individual Corporate OfficerPresident & Ceo Oct 1, 2023
Operational/Managerial ControlPresident and Ceo Oct 1, 2023
Self Regional Healthcare Organization, Greenwood, SC Non-profit Operational/Managerial Control Oct 1, 2023 100%
William F Gordon Individual Corporate OfficerCao Jan 11, 2024
W-2 Managing Employee Jan 11, 2024
Clint J Stewart Individual Corporate OfficerVP & Cfo Oct 21, 2024
W-2 Managing Employee Oct 21, 2024

Owners & managing parties with NPI records 17

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

View all 17

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Abbeville Area Healthcare CenterAbbeville, SC, CCN 423451 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2010
Due West Family MedicineDue West, SC, CCN 423453 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2016

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 9

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

Practitioners & affiliated clinicians

Practitioners 105

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 105

Affiliated clinicians 192

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

View all 192

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730764800000",
    "number": "1063449361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 887",
            "city": "ABBEVILLE",
            "state": "SC",
            "postal_code": "296200887",
            "telephone_number": "864-336-3279",
            "fax_number": "864-366-3317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 THOMSON CIR",
            "city": "ABBEVILLE",
            "state": "SC",
            "postal_code": "29620",
            "telephone_number": "864-366-5011",
            "fax_number": "864-366-3317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABBEVILLE COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "TOLBERT",
        "authorized_official_title_or_position": "PRESIDENT/ CEO",
        "authorized_official_telephone_number": "864-725-4780"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "SC",
            "license": "HTL-098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142571",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "400612",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "252726",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "AthenaEHR",
            "affiliation": "N",
            "endpointDescription": "Electronic Health Records shared with all providers in the organization",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "EHR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Encrypted PDF",
            "address_1": "420 Thomson Cir",
            "city": "Abbeville",
            "state": "SC",
            "country_code": "US",
            "postal_code": "29620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Abbeville Area Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Abbeville, SC

Sources for this page

Verify at the official NPI Registry.