NPIMap

Organization Active NPI

Spartanburg Medical Center

Doing business as Spartanburg Regional Hospice

  • Community Based Hospice Care Agency
  • Drayton, SC
National Provider Identifier
1194745190
Registry record updated Dec 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
HPC-003 Issued in SC
Legal business name
SPARTANBURG MEDICAL CENTER
Doing business as
Spartanburg Regional Hospice
Practice address
1530 Drayton Road
Drayton, SC 29333-0430
Phone
(864) 560-3900
Fax
(864) 560-3998
NPI assigned
Jul 20, 2006
Last updated
Dec 19, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 19, 2018

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

Authorized official

Name
Kenneth J Meinke
Title
Chief Financial Officer
Phone
(864) 560-6103

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X HPC-003 SC Primary

Addresses

Primary practice location

1530 Drayton Road
Drayton, SC 29333-0430

Mailing address

PO Box 277723
Atlanta, GA 30384-7723
Phone (864) 560-4123

Other identifiers 1

IdentifierTypeStateIssuer
HSP025MedicaidSC

Other names 1

  • Spartanburg Regional Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120220000273 SC Part A Provider - Hospice 3072425297 Practice locations: Drayton, SC; Spartanburg, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194745190. Details of each certification follow.

Hospice certification: CCN 421500

Legal name
SPARTANBURG MEDICAL CENTER
Doing business as
SPARTANBURG REGIONAL HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 15, 1984
Last certification
Jan 15, 2021
Ownership / control type
Non-Profit - Other
Organization structure
OtherNon-profit
Incorporated
May 1, 1995 in SC
Enrollment address
101 E Wood St
Spartanburg, SC 29303-3040

Other NPIs with the same Medicare PAC ID 16

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

View all 16

Care Compare: Hospice

Medicare Care Compare
Listed as
Spartanburg Regional Med Ctr HospiceCCN 421500 · All quality measures
Ownership
Non-Profit
Certified
Mar 15, 1984
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Harriett Goodrich PA136 organizations share this tax ID, including this one
Part of
Spartanburg Regional Health Services District Inc

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

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
Kristi Denise Ford-Scales Individual Corporate DirectorMedical Director - Hospice Sep 1, 2021 100%
W-2 Managing EmployeeMedical Director - Hospice Sep 1, 2021 100%
Mark Kenneth Nix Individual W-2 Managing EmployeeAdministrator - Hospice Feb 1, 2021 100%
Spartanburg Medical Center Organization, Spartanburg, SC 5% Or Greater Direct Ownership Interest May 1, 1995 100%
Operational/Managerial Control May 1, 1995 100%
Philip Feisal Individual W-2 Managing EmployeeSenior VP Jun 1, 2011
Operational/Managerial ControlSenior VP Jun 1, 2011
Mark a Aycock Individual Corporate OfficerExecutive VP Feb 1, 2009
W-2 Managing EmployeeExecutive VP Feb 1, 2009
Operational/Managerial ControlExecutive VP Feb 1, 2009
Elmer B Holstien Individual W-2 Managing EmployeePresident & Ceo Aug 1, 2011 5%
Operational/Managerial ControlPresident & Ceo Aug 1, 2011 5%
Bruce a Davis Individual Corporate OfficerCfo Jan 25, 2020
W-2 Managing EmployeeCfo Jan 25, 2020
Operational/Managerial ControlCfo Jan 25, 2020

Owners & managing parties with NPI records 17

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Kristi Denise Ford-Scales, MD
    • Hospice and Palliative Medicine (Family Medicine) Physician
    • Spartanburg, SC
    • NPI 1366753535

    Corporate Director, W-2 Managing Employee

    CMS ownership
  • Spartanburg Medical Center

    dba Medical Group of the Carolinas - Family Medicine - Converse Heights

    • Family Medicine Physician
    • Spartanburg, SC
    • NPI 1003900143

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Spartanburg Medical Center

    dba Medical Group of the Carolinas - Diabetes and Endocrinology - Spartanb

    • Endocrinology, Diabetes & Metabolism Physician
    • Spartanburg, SC
    • NPI 1033150875

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Spartanburg Medical Center

    dba Spartanburg Medical Center- Psychiatric Unit

    • Psychiatric Hospital Unit
    • Spartanburg, SC
    • NPI 1033681630

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Spartanburg Medical Center

    dba Medical Group of the Carolinas - Spineand Pain Management - NorthGrove

    • Neuromusculoskeletal Medicine & OMM Physician
    • Spartanburg, SC
    • NPI 1043309917

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Spartanburg Medical Center

    dba That Special Look

    • Customized Equipment (DME)
    • Spartanburg, SC
    • NPI 1114017688

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Spartanburg Medical Center

    dba Medical Group of the Carolinas - Family Medicine - Boiling Springs

    • Family Medicine Physician
    • Boiling Springs, SC
    • NPI 1235170077

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Spartanburg Medical Center

    dba That Special Look - Pelham

    • Durable Medical Equipment & Medical Supplies
    • Greer, SC
    • NPI 1255963088

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Spartanburg Medical Center

    dba Medical Group of the Carolinas - Woman's Clinic

    • Obstetrics & Gynecology Physician
    • Spartanburg, SC
    • NPI 1396981403

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Spartanburg Medical Center

    dba Spartanburg Regional Home Health

    • Home Health Agency
    • Spartanburg, SC
    • NPI 1558381541

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Spartanburg Medical Center

    dba Medical Group of the Carolinas - Diabetes and Endocrinology - Pelham

    • Endocrinology, Diabetes & Metabolism Physician
    • Greer, SC
    • NPI 1558465005

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Spartanburg Medical Center
    • General Acute Care Hospital
    • Spartanburg, SC
    • NPI 1609807122

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
View all 17

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Spartanburg Medical CenterSpartanburg, SC, CCN 420007 Hospital Operational/Managerial Control Nov 27, 2007
Spartanburg Medical CenterSpartanburg, SC, CCN 42S007 Hospital Operational/Managerial Control Nov 27, 2007
Spartanburg Medical CenterSpartanburg, SC, CCN 42T007 Hospital Operational/Managerial Control Nov 27, 2007
CMC - Center for OB/GYNGaffney, SC, CCN 423492 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 10, 2021

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Affiliated clinicians 7

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": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545177600000",
    "number": "1194745190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 277723",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303847723",
            "telephone_number": "864-560-4123",
            "fax_number": "864-560-4023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 DRAYTON ROAD",
            "city": "DRAYTON",
            "state": "SC",
            "postal_code": "293330430",
            "telephone_number": "864-560-3900",
            "fax_number": "864-560-3998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARTANBURG MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPARTANBURG REGIONAL HEALTH SERVICES DISTRICT, INC.",
        "enumeration_date": "2006-07-20",
        "last_updated": "2018-12-19",
        "status": "A",
        "authorized_official_last_name": "MEINKE",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "864-560-6103"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "SC",
            "license": "HPC-003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP025",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spartanburg Regional Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spartanburg Regional Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Drayton, SC

Sources for this page

Verify at the official NPI Registry.