NPIMap

Organization Active NPI

Charleston-Amg Specialty Hospital, Inc.

Doing business as Charleston-AMG Specialty Hospital

  • Long Term Care Hospital
  • Mount Pleasant, SC
National Provider Identifier
1174345318
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
Legal business name
CHARLESTON-AMG SPECIALTY HOSPITAL, INC.
Doing business as
Charleston-AMG Specialty Hospital
Practice address
1200 Hospital Dr
Mt Pleasant, SC 29464-3251
Phone
(337) 269-9566
NPI assigned
Oct 29, 2024
Last updated
Oct 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Authorized official

Name
Ms. Jessica L McGee
Title
Cfo
Phone
(337) 269-9566

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Hospital 282E00000X Primary

Addresses

Primary practice location

1200 Hospital Dr
Mt Pleasant, SC 29464-3251

Mailing address

101 La Rue France Ste 500
Lafayette, LA 70508-3144
Phone (337) 269-9566

Other names 1

  • Charleston-AMG Specialty Hospital Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20250204001153 SC Part A Provider - Hospital 7618407867 Practice locations: Mt Pleasant, SC
O20250312000784 SC Part B Supplier - Hospital Department(S) 7618407867 Receives reassigned benefits from 18 practitioners
Practice locations: Mt Pleasant, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174345318. Details of each certification follow.

Hospital certification: CCN 422005

Legal name
CHARLESTON-AMG SPECIALTY HOSPITAL INC
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Jul 1, 1999
Last certification
Jan 17, 2018
Beds
59
Ownership / control type
Private (for profit)
Most recent change of ownership
Jan 1, 2025 (2 total)
Organization structure
CorporationProprietary
Enrollment address
1200 Hospital Dr
FL 3
Mt Pleasant, SC 29464-3251
Main/Primary Hospital Location
Hospital subgroups
Long-term

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
Charleston-Amg Speciality Hospital IncCCN 422005 · All quality measures
Ownership
For profit
Certified
Jul 1, 1999
Medicare certification status
ActiveFrom the Provider of Services file
Beds
59

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Dennis Bencomo Individual Contracted Managing EmployeeAd; Mar 4, 2025 50%
Rantz IV Enterprises LLC Organization, Lafayette, LA Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2025 50%
Timothy W Howard Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2025 25%
Corporate OfficerCeo Jan 1, 2025 50%
Jessica L McGee Individual Corporate OfficerCfo Nov 1, 2024 25%
Amg 4.0, LLC Organization, Lafayette, LA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2025 100%
Benjamin Miller Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2025 25%
Corporate OfficerCoo Jan 1, 2025 50%
August J Rantz Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2025 50%
Corporate OfficerPresident Jan 1, 2025 50%

Facilities with the same owner 4

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

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 20

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 20

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1730160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1174345318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 LA RUE FRANCE STE 500",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083144",
            "telephone_number": "337-269-9566",
            "fax_number": "337-269-9823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 HOSPITAL DR",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294643251",
            "telephone_number": "337-269-9566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLESTON-AMG SPECIALTY HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-29",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "MCGEE",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "337-269-9566",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charleston-AMG Specialty Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Pleasant, SC

Sources for this page

Verify at the official NPI Registry.