Pruitthealth Hospice, Inc.
Organization Active NPI Community Based Hospice Care Agency · Anderson, SC
NPI 1174878342 · NPPES record last updated Apr 29, 2021
Key facts
- NPI
- 1174878342
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- PRUITTHEALTH HOSPICE, INC.
- Practice address
- 1510 N Fant St
Anderson, SC 29621-4708 - Phone
- (864) 226-1219
- Fax
- (864) 226-8730
- NPI assigned
- Jul 13, 2012
- Organization subpart
- Yes
- Parent organization (as reported)
- PRUITTHEALTH HOSPICE, INC.
Authorized official
- Name
- Neil L Pruitt Jr.
- Title
- Chairman and Ceo
- Phone
- (770) 279-6200
Other NPIs on the same Medicare enrollment 7
Other NPIs with the same Medicare PAC ID 17
Corporate family (same tax ID) 24
Practitioners 47
-
Stacey Lynn Childress, AGPCNP
-
Erin Pruitt Drennon, FNP - BC
-
Jessica Marie Hellman, NURSE PRACTITIONER
-
Faye D Jennings, NP
-
Kimberlee Kay Saunders, AGPCNP
-
Sarah Simmons, APRN
-
Kristin Claude, APRN
-
Dana Lenore Smith, APRN
-
Beth Ann Mengelt, FNP-C
-
Martha J Sullivan, CNP CERTIFIED NURSE
-
Rhonda Rachels, APRN
-
Valorie M Bogue, NP-C
-
Ashley Brimmer, FNP-C
-
Ama Browne, NP
-
Cynthia Jill Martin Clark, FNP-C
-
Kendra Jordan Cook, APRN/NP
-
Rosa Credle, FNP
-
Jenna M Darby, MSN, FNP
Affiliated clinicians 12
-
Jason K Barber, M.D.
-
Ishan Bhansaly, M.D.
-
David Jonathan Budhoo, M.D.
-
Binyue Chang, M.D.
-
Conigliaro Jones, MD
-
Kerry Lewayne Wheeler, D.O.
-
Dennis Tambe Besong, M.D.
-
Chacey Bryan, M.D.
Medicare Care Compare: Hospice
- Listed as
- Pruitthealth Hospice- Columbia
- Ownership
- For-Profit
- Certified
- Apr 11, 2006
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 42D2048684 | Pruitthealth Hospice Anderson, Inc | Certificate of waiver | Oct 21, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SC
Hospice certification: CCN 421565
- Legal name
- PRUITTHEALTH HOSPICE INC
- Doing business as
- PRUITTHEALTH HOSPICE-COLUMBIA
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Apr 11, 2006
- Last certification
- Feb 25, 2022
- Ownership / control type
- Proprietary - Individual
- Organization structure
- Corporation · Proprietary
- Incorporated
- Oct 14, 1993 in GA
- Enrollment address
- 240 Stoneridge Dr
Ste 302
Columbia, SC 29210-8013
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Lance Danko |
W-2 Managing Employee | Oct 27, 2017 | 100% |
| Hannah Burris |
W-2 Managing Employee |
Oct 18, 2021 | |
| United Health Services Inc |
5% Or Greater Direct Ownership Interest | May 15, 2003 | 100% |
| Angela D. McCarn |
W-2 Managing Employee | Jul 1, 2020 | |
| Pruitthealth Inc |
5% Or Greater Direct Ownership Interest | Jan 1, 2022 | |
| Operational/Managerial Control | Jan 7, 2008 | ||
| Lisa P Hamby Trust |
5% Or Greater Indirect Ownership Interest | Jan 2, 2006 | 28.84% |
| Neil Little Pruitt |
Corporate Officer | Apr 12, 1999 | |
| Corporate Director | Jan 3, 2006 | ||
| Neil L Pruitt Jr Trust |
5% Or Greater Indirect Ownership Interest | Jan 2, 2006 | 35.19% |
| Teresa Sexton |
W-2 Managing Employee | Sep 19, 2019 | 100% |
| Uhs-Pruitt Holdings, Inc. |
5% Or Greater Indirect Ownership Interest | Jan 2, 2006 | 100% |
| Thomas R Beddingfield |
Corporate Director |
Sep 17, 2013 | |
| United Health Services of Georgia, Inc. |
5% Or Greater Direct Ownership Interest | Oct 31, 2003 | |
| J Paige Pruitt Trust |
5% Or Greater Indirect Ownership Interest | Jan 2, 2006 | 31.32% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060103000094 | SC | Part a Provider - Hospice | 2264344217 |
3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Columbia, SC; Anderson, SC; Greenville, SC |
| O20221214002911 | SC | Part B Supplier - Clinic/Group Practice | 2264344217 |
Receives reassigned benefits from 16 practitioners 6 other NPIs on this enrollment Practice locations: Okatie, SC; Ladson, SC; Greenville, SC; Columbia, SC; Anderson, SC; Aiken, SC; Florence, SC |
National Provider Directory
- Tax ID family
- Pruitthealth Hospice Inc
- Part of
- Pruitthealth Hospice Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
1510 N Fant St
Anderson, SC 29621-4708
Mailing address
1626 Jeurgens CT
Legal Dept
Norcross, GA 30093-2219
Phone (770) 279-6200
Other names
- PruittHealth Hospice - Anderson
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All providers in Anderson, SC · Community Based Hospice Care Agency 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 Apr 29, 2021. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.