NPIMap

Organization Active NPI

Carolina Health Centers, Inc.

  • Family Medicine Physician
  • MC Cormick, SC
National Provider Identifier
1063545119
Registry record updated Jun 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CAROLINA HEALTH CENTERS, INC.
Practice address
1319 S Main St
MC Cormick, SC 29835-7928
Phone
(864) 852-3336
Fax
(864) 852-3339
NPI assigned
Mar 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2023

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

Authorized official

Name
Mrs. Lisa Y Gilmer
Title
Practice Administrator
Phone
(864) 941-8121

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Federally Qualified Health Center (FQHC) 261QF0400X

Addresses

Primary practice location

1319 S Main St
MC Cormick, SC 29835-7928

Mailing address

219A North Mine Street
McCormick, SC 29835
Phone (864) 852-3336

Other identifiers 1

IdentifierTypeStateIssuer
FQC002MedicaidSC

Other names 1

  • McCormick Family Practice Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050825000437 SC Part B Supplier - Clinic/Group Practice 5496707804 Receives reassigned benefits from 37 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ridge Spring, SC; Waterloo, SC; Ware Shoals, SC; Saluda, SC; MC Cormick, SC; Greenwood, SC; Clinton, SC; Calhoun Falls, SC
O20090303000391 SC Part A Provider - Federally Qualified Health Center (FQHC) 5496707804 Practice locations: MC Cormick, SC

Federally qualified health center certification: CCN 421815

Legal name
CAROLINA HEALTH CENTERS INC
Doing business as
MCCORMICK FAMILY PRACTICE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 1, 1992
Last certification
Jun 1, 1992
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 27, 1977 in SC
Enrollment address
1319 S Main St
MC Cormick, SC 29835-7928

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Other NPIs on the same Medicare enrollment 10

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

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
42D0995117McCormick Family Practice Center1319 S Main Street, MC Cormick, SC 29835Certificate of waiverJun 21, 2027

National Provider Directory

National Provider Directory

Locations

420 Epting Ave
#B
Greenwood, SC 29646
Phone (864) 547-8250

219A N Mine St
Mc Cormick, SC 29835
Phone (864) 852-3336

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Christopher Scott Clem Individual Corporate OfficerChief Financial Officer Jun 16, 2025
Mary Stackhouse Individual Corporate DirectorBoard Member Mar 26, 1998
Abby Banks Individual Corporate DirectorBoard Member Sep 24, 2012
Kimberly Kapetanakos Individual Corporate DirectorBoard Member Apr 24, 2017
Malcolm O'Neal Individual Corporate DirectorBoard Member Sep 29, 2014
Miriam Ferguson Individual Corporate OfficerActing Ceo Jul 14, 2025 100%
Mario Luna Individual Corporate DirectorBoard Member Sep 24, 2014
Gail D Ferguson Individual Corporate DirectorBoard Member Jul 1, 1994
John Britt Individual Corporate DirectorBoard Member Aug 1, 1992
Gregory Bullard Individual Corporate OfficerBoard Chair Jun 25, 1985
Corporate DirectorBoard Chair Jun 1, 1995
Deborah Natvig Individual Corporate DirectorBoard Member Feb 22, 2010
Paul Grogan Individual W-2 Managing EmployeeCfo Aug 6, 2012
Locke Eugene Simons Individual Corporate DirectorMedical Director Jun 1, 2012

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686096000000",
    "number": "1063545119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219A NORTH MINE STREET",
            "city": "MCCORMICK",
            "state": "SC",
            "postal_code": "29835",
            "telephone_number": "864-852-3336",
            "fax_number": "864-852-3339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1319 S MAIN ST",
            "city": "MC CORMICK",
            "state": "SC",
            "postal_code": "298357928",
            "telephone_number": "864-852-3336",
            "fax_number": "864-852-3339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA HEALTH CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A",
        "authorized_official_last_name": "GILMER",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "864-941-8121",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC002",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McCormick Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "McCormick Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in MC Cormick, SC

Sources for this page

Verify at the official NPI Registry.