NPIMap

Organization Active NPI

Eau Claire Cooperative Health Center, Inc.

Doing business as Eau Claire Podiatry

  • Podiatrist
  • Columbia, SC
National Provider Identifier
1093093346
Registry record updated Oct 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Doing business as
Eau Claire Podiatry
Practice address
4605 Monticello Rd Ste 2
Building B
Columbia, SC 29203-4156
Phone
(803) 705-3172
Fax
(803) 705-3173
NPI assigned
Aug 3, 2011
Last updated
Oct 12, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2026

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

Authorized official

Name
Dana Schultz
Title
Cfo
Phone
(305) 587-7375

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X Primary

Addresses

Primary practice location

4605 Monticello Rd Ste 2
Building B
Columbia, SC 29203-4156

Mailing address

PO Box 3788
Columbia, SC 29230-3788
Phone (803) 733-5969

Other identifiers 3

IdentifierTypeStateIssuer
FQC165MedicaidSC
FQC031MedicaidSC
CBP018MedicaidSC

Other names 1

  • Eau Claire Podiatry 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…
O20120907000255 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 1093093346. Details of each certification follow.

Federally qualified health center certification: CCN 421968

Legal name
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Doing business as
EAU CLAIRE PODIATRY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 7, 2012
Last certification
Sep 7, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 14, 1992 in SC
Enrollment address
3800 N Main St
Ste B
Columbia, SC 29203-6446

Other NPIs on the same Medicare enrollment 23

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

View all 23

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
42D2289598Eau Claire Podiatry3800 North Main Street, Suite B, Columbia, SC 29203Certificate of waiverSep 12, 2027

National Provider Directory

National Provider Directory
Tax ID family
Winnsboro Pediatrics Famil44 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

Locations

1115 State St
Cayce, SC 29033
Phone (803) 939-0174

3800 N Main St
Columbia, SC 29203

3800 N Main St
Ste B
Columbia, SC 29203
Phone (803) 705-3172

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Eau Claire Cooperative Health Center, Inc. Organization, Columbia, SC Corporation, Non-profit 5% Or Greater Direct Ownership Interest Mar 7, 2022
Karena S White Individual W-2 Managing Employee Mar 1, 2022
Junior Delgado Cantave Individual Contracted Managing Employee Sep 28, 2016
Corporate Director Sep 28, 2016
W-2 Managing Employee Sep 28, 2016

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
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
Advantage Eye CareColumbia, SC, CCN 871038 Federally qualified health center 5% Or Greater Direct Ownership Interest Jun 1, 2022

Facilities with the same owner 13

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

View all 13

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1312329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791763200000",
    "number": "1093093346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3788",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292303788",
            "telephone_number": "803-733-5969",
            "fax_number": "803-753-5591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 MONTICELLO RD STE 2",
            "address_2": "BUILDING B",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292034156",
            "telephone_number": "803-705-3172",
            "fax_number": "803-705-3173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-03",
        "last_updated": "2026-10-12",
        "certification_date": "2026-10-12",
        "status": "A",
        "authorized_official_last_name": "SCHULTZ",
        "authorized_official_first_name": "DANA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "305-587-7375"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC165",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC031",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CBP018",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eau Claire Podiatry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eau Claire Podiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.