Community Medicine Foundation, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Rock Hill, SC
NPI 1154861045 · NPPES record last updated Feb 27, 2017
Key facts
- NPI
- 1154861045
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- COMMUNITY MEDICINE FOUNDATION, INC
- Practice address
- 1140 Saluda Street
Women'S Health and Pediatric /Adolescent Center
Rock Hill, SC 29730 - Phone
- (803) 325-7744
- Fax
- (803) 325-1117
- NPI assigned
- Feb 27, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- COMMUNITY MEDICINE FOUNDATION, INC
Authorized official
- Name
- Ernest Brown
- Title
- Ceo
- Phone
- (803) 325-7744
Other NPIs on the same Medicare enrollment 5
Corporate family (same tax ID) 16
Practitioners 2
-
Jacquelyn S. Gill, M.D
-
Veleka Mayfield, FNP BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040407001159 | SC | Part B Supplier - Clinic/Group Practice | 4880687490 |
Receives reassigned benefits from 19 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Chester, SC; Rock Hill, SC |
National Provider Directory
- Tax ID family
- Community Med Foundation
- Part of
- Community Med Foundation
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1140 Saluda Street
Women'S Health and Pediatric /Adolescent Center
Rock Hill, SC 29730
Mailing address
1131 Saluda Street
North Central Family Medical Center
Rock Hill, SC 29730-5776
Phone (803) 325-7744
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| FQC025 | Medicaid | SC |
Other names
- NORTH CENTRAL FAMILY MEDICAL CENTER
NPI Registry JSON
{
"created_epoch": "1488153600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1488153600000",
"number": "1154861045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1131 SALUDA STREET",
"address_2": "NORTH CENTRAL FAMILY MEDICAL CENTER",
"city": "ROCK HILL",
"state": "SC",
"postal_code": "297305776",
"telephone_number": "803-325-7744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1140 SALUDA STREET",
"address_2": "WOMEN'S HEALTH AND PEDIATRIC /ADOLESCENT CENTER",
"city": "ROCK HILL",
"state": "SC",
"postal_code": "29730",
"telephone_number": "803-325-7744",
"fax_number": "803-325-1117"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COMMUNITY MEDICINE FOUNDATION, INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "COMMUNITY MEDICINE FOUNDATION, INC",
"enumeration_date": "2017-02-27",
"last_updated": "2017-02-27",
"status": "A",
"authorized_official_last_name": "BROWN",
"authorized_official_first_name": "ERNEST",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "803-325-7744"
},
"taxonomies": [
{
"code": "261QF0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "FQC025",
"state": "SC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "NORTH CENTRAL FAMILY MEDICAL CENTER",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Rock Hill, SC
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- Community Medicine Foundation
- Community Medicine Foundation
- Community Medicine Foundation Inc
- Community Medicine Foundation Inc
- Community Medicine Foundation, Inc.
- Compassion Counseling Services
- Compassionate Senior Home Care
- Compleat Rehab & Sports Therapy Center
- Concepts in Communication,LLC
All providers in Rock Hill, SC · Federally Qualified Health Center (FQHC) 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 Feb 27, 2017. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.