NPIMap

Organization Active NPI

McLeod Regional Medical Center of the Pee Dee, Inc

Doing business as Cbo MRMC Emergency

  • Emergency Medical Services (Emergency Medicine) Physician
  • Florence, SC
National Provider Identifier
1154371433
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
Legal business name
MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC
Doing business as
Cbo MRMC Emergency
Practice address
555 E Cheves St
Florence, SC 29506-2617
Phone
(843) 777-2000
Fax
(843) 777-5035
NPI assigned
May 10, 2006
Last updated
Mar 19, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MCLEOD HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Authorized official

Name
Samuel Fulton Ervin III
Title
Senior VP and Cfo
Phone
(843) 777-2910

Specialties & licenses 14

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X
Registered Dietitian 133V00000X
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X Primary
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X
Critical Care Medicine (Internal Medicine) Physician 207RC0200X
Endocrinology, Diabetes & Metabolism Physician 207RE0101X
Gastroenterology Physician 207RG0100X
Hematology & Oncology Physician 207RH0003X
Interventional Cardiology Physician 207RI0011X
Pediatric Endocrinology Physician 2080P0205X
Neurology Physician 2084N0400X
Psychiatric/Mental Health Nurse Practitioner 363LP0808X
Certified Registered Nurse Anesthetist 367500000X

Addresses

Primary practice location

555 E Cheves St
Florence, SC 29506-2617

Mailing address

PO Box 100567
Florence, SC 29502-0567
Phone (843) 777-5802

Other practice location 1

3980 Highway 9 E Ste 300
Little River, SC 29566-8165
Phone (843) 366-3891

Other practice location 2

401 E Cheves St Ste 201
Florence, SC 29506-2615
Phone (843) 777-7951

Other practice location 3

701 Cashua Ferry Rd
Darlington, SC 29532-8488
Phone (843) 777-1100

Other identifiers 1

IdentifierTypeStateIssuer
400514MedicaidSC

Other names 1

  • CBO MRMC EMERGENCY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031126000251 SC Part B Supplier - Clinic/Group Practice 7416851852 Receives reassigned benefits from 828 practitioners
2 other NPIs on this enrollment
Practice locations: Little River, SC; Sumter, SC; North Myrtle Beach, SC; Myrtle Beach, SC; Loris, SC; Florence, SC; Darlington, SC

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

1001 W Sumter St
Florence, SC 29501
Phone (843) 676-1400

401 E Cheves St
Ste 301
Florence, SC 29506
Phone (843) 777-7166

800 E Cheves St
Ste 370
Florence, SC 29506
Phone (843) 665-2153

4000 Highway 9 E
Ste 250
Little River, SC 29566
Phone (843) 366-3891

101 McLeod Health Blvd
Ste 201
Myrtle Beach, SC 29579
Phone (843) 646-8001

107 McLeod Health Blvd
Ste 202
Myrtle Beach, SC 29579
Phone (843) 798-4194

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Hospice of the Pee DeeFlorence, SC, CCN 421516 Hospice 5% Or Greater Direct Ownership Interest Jul 3, 2003

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 854

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 854

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1154371433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100567",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295020567",
            "telephone_number": "843-777-5802",
            "fax_number": "843-777-5035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 E CHEVES ST",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295062617",
            "telephone_number": "843-777-2000",
            "fax_number": "843-777-5035"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3980 Highway 9 E Ste 300",
            "address_purpose": "LOCATION",
            "city": "Little River",
            "state": "SC",
            "postal_code": "295668165",
            "country_code": "US",
            "telephone_number": "843-366-3891",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "401 E Cheves St Ste 201",
            "address_purpose": "LOCATION",
            "city": "Florence",
            "state": "SC",
            "postal_code": "295062615",
            "country_code": "US",
            "telephone_number": "843-777-7951",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "701 Cashua Ferry Rd",
            "address_purpose": "LOCATION",
            "city": "Darlington",
            "state": "SC",
            "postal_code": "295328488",
            "country_code": "US",
            "telephone_number": "843-777-1100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCLEOD HEALTH",
        "enumeration_date": "2006-05-10",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "ERVIN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "FULTON",
        "authorized_official_title_or_position": "SENIOR VP AND CFO",
        "authorized_official_telephone_number": "843-777-2910",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "400514",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CBO MRMC EMERGENCY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CBO MRMC EMERGENCY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Florence, SC

Sources for this page

Verify at the official NPI Registry.