NPIMap

Organization Active NPI

Careteam Plus, Inc.

  • Federally Qualified Health Center (FQHC)
  • Conway, SC
National Provider Identifier
1194541383
Registry record updated Dec 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CARETEAM PLUS, INC.
Practice address
132 Professional Park Dr
Conway, SC 29526-9260
Phone
(843) 234-0005
NPI assigned
Dec 3, 2024
Last updated
Dec 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2024

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

Authorized official

Name
Johanna L HaynesNPI 1356002109
Title
Ceo
Phone
(843) 234-8220

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Pediatrics Physician 208000000X NU

Addresses

Primary practice location

132 Professional Park Dr
Conway, SC 29526-9260

Mailing address

100 Professional Park Dr
Conway, SC 29526-9260
Phone (843) 234-0005

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120106000726 SC Part B Supplier - Clinic/Group Practice 2961678289 Receives reassigned benefits from 16 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Conway, SC; Georgetown, SC; Pawleys Island, SC
O20250508001303 SC Part A Provider - Federally Qualified Health Center (FQHC) 2961678289 Practice locations: Conway, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194541383. Details of each certification follow.

Federally qualified health center certification: CCN 421113

Legal name
CARETEAM PLUS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 13, 2025
Last certification
Jan 13, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
132 Professional Park Dr
Conway, SC 29526

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Careteam Plus Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Johanna Haynes Individual Corporate Director Apr 1, 2011
W-2 Managing Employee Apr 1, 2011

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Careteam Plus IncConway, SC, CCN 421057 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 20, 2018
Careteam Plus IncPawleys Island, SC, CCN 421095 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 20, 2018

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1733184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734566400000",
    "number": "1194541383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PROFESSIONAL PARK DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295269260",
            "telephone_number": "843-234-0005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 PROFESSIONAL PARK DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295269260",
            "telephone_number": "843-234-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARETEAM PLUS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-03",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "JOHANNA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-234-8220"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, SC

Sources for this page

Verify at the official NPI Registry.