McLeod Medical Center-Dillon
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Dillon, SC
NPI 1124487541 · NPPES record last updated May 22, 2019
Key facts
- NPI
- 1124487541
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- License
- HTL-0631 (SC)
- Legal business name
- MCLEOD MEDICAL CENTER-DILLON
- Practice address
- 301 E Jackson St
Dillon, SC 29536-2509 - Phone
- (843) 774-4111
- NPI assigned
- Feb 12, 2016
- Organization subpart
- Yes
- Parent organization (as reported)
- MCLEOD HEALTH
Authorized official
- Name
- Mr. Samuel Fulton Ervin III
- Title
- Sr. VP & Cfo
- Phone
- (843) 777-2910
Owners & managing parties with NPI records 9
-
Tarek M Bishara, MD
-
Patrick Kerry Denton, M.D.
-
Amit V. Pande, M.D.
-
Tracy P. Ray, OD
-
James C.H. Smith, MD
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 2
Related certifications (CCN) 1
Facilities with the same owner 17
Practitioners 120
-
Alto Bernat Odin Jr., D.O.
-
James Nicholas Wallace, M.D.
-
William McCall Goldstein, M.D.
-
Toney Graham III, MD
-
Fadi Asfahan, MD
-
Anthony Adetola Odubanjo, M.D.
-
Kazim Aykent, MD
-
Susan Michelle Babb, CRNA
-
Donya T Baker, CRNA
-
Robert Maybon Barber, CRNA
-
Alan M Blaker, M.D.
-
Eileen Brown, CRNA
-
Kristin Renee Cain, CRNA
-
Rachel Bowen Caulder, CRNA
-
Sara Morgan Clark, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Hospital certification: CCN 42U005
- Legal name
- MCLEOD MEDICAL CENTER-DILLON
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 3, 2003 in SC
- Enrollment address
- 301 E Jackson St
Dillon, SC 29536-2509 - Hospital subgroups
- Swing-bed approved
All disclosed owners & managing parties 30
| Name | Role | Since | Share |
|---|---|---|---|
| Willie E Boyd |
Corporate Officer |
Feb 1, 2016 | |
| J Douglas Lynn |
Corporate Officer |
Jan 1, 2026 | |
| David Oren Atkinson |
Corporate Officer |
Jan 1, 2026 | |
| Matthew Prince |
Corporate Officer |
Jan 1, 2026 | |
| Frances S Jones |
Corporate Director |
Feb 1, 2016 | |
| Ashley Brady |
Corporate Officer |
Jan 1, 2018 | |
| William N Boulware |
Corporate Officer |
Feb 1, 2016 | |
| Shelia Rollins |
W-2 Managing Employee |
Jan 1, 2026 | |
| John M Scott |
Corporate Officer |
Jan 1, 2026 | |
| Christian Soura |
Corporate Officer |
Jan 1, 2026 | |
| Ronald M Fowler |
Corporate Officer |
Feb 1, 2016 | |
| Dudley B. Harrington |
Corporate Officer |
Jan 1, 2018 | |
| Virginia L Clyburn-Ipock |
Corporate Officer |
Jun 1, 2021 | |
| Jeannette Glenn |
Corporate Officer |
Jan 1, 2018 | |
| McLeod Health |
5% Or Greater Direct Ownership Interest | Jul 3, 2003 | 100% |
| Samuel F Ervin |
Corporate Officer |
Feb 1, 2016 | |
| Marwan Kamil Elya |
Corporate Officer |
Jan 1, 2026 | |
| Hugh S Blair |
Corporate Officer |
Jan 1, 2018 | |
| Mary Anderson |
Corporate Officer |
Jan 1, 2018 | |
| Tracy Ray |
Corporate Officer |
Feb 1, 2016 | |
| Virginia Hardee |
W-2 Managing Employee |
Jan 1, 2026 | |
| Donna Isgett |
Corporate Officer |
Mar 1, 2021 | |
| Tarek M Bishara |
Corporate Officer |
Jan 1, 2018 | |
| Beverly Hazelwood |
Corporate Officer |
Jan 1, 2018 | |
| Amy Fisher |
Corporate Officer | Jun 1, 2021 | |
| Amit Vyankatesh Pande |
Corporate Officer |
Jun 1, 2021 | |
| Frank V Boulineau |
Corporate Officer |
Feb 1, 2016 | |
| Patrick Kerry Denton |
Corporate Officer |
Jan 1, 2018 | |
| Frank J Brand |
Corporate Officer |
Feb 1, 2016 | |
| James C Smith |
Corporate Officer |
Jan 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160331001727 | SC | Part a Provider - Hospital | 3476465311 | Practice locations: Dillon, SC |
National Provider Directory
- Tax ID family
- McLeod Medical Center-Dillon
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | HTL-0631 | SC | Yes |
Addresses
Primary practice location
301 E Jackson St
Dillon, SC 29536-2509
Mailing address
301 E Jackson St
Dillon, SC 29536-2509
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42U005 | Other | SC | MEDICARE ID |
| 0854SB | Medicaid | SC | |
| C046NF | Medicaid | SC |
Other providers in Dillon, SC
- Paige McEachin
- Samantha Maria McKenzie
- McLeans Loving & Caring Home Care Service
- Eugene McLellan
- Shawna Lomeica McLellan
- McLeod Medical Center-Dillon
- McLeod Medical Center-Dillon
- McLeod Physician Associates II
- McLeod Physician Associates II
- McLeod Physician Associates II
All providers in Dillon, SC · Medicare Defined Swing Bed Hospital Unit 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 May 22, 2019. 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.