NPIMap

Organization Active NPI

McLeod Health Clarendon

  • Rural Acute Care Hospital
  • Manning, SC
National Provider Identifier
1205284411
Registry record updated Apr 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Acute Care HospitalTaxonomy code 282NR1301X
Legal business name
MCLEOD HEALTH CLARENDON
Practice address
10 E Hospital St
Manning, SC 29102-3153
Phone
(803) 435-8463
NPI assigned
May 27, 2016
Last updated
Apr 17, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
MCLEOD HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 17, 2020

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

Authorized official

Name
Mr. Samuel Fulton Ervin III
Title
Sr Vice President and Cfo
Phone
(843) 777-2910

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Acute Care Hospital 282NR1301X Primary

Addresses

Primary practice location

10 E Hospital St
Manning, SC 29102-3153

Mailing address

10 E Hospital St
Manning, SC 29102-3153

Other identifiers 3

IdentifierTypeStateIssuer
42-0109OtherSCMEDICARE
BL0930MedicaidSC
AL0930MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160714000376 SC Part A Provider - Hospital 0840582656 Practice locations: Manning, SC; Sumter, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205284411. Details of each certification follow.

Hospital certification: CCN 420109

Legal name
MCLEOD HEALTH CLARENDON
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Aug 5, 2016
Last certification
Jun 29, 2022
Beds
81 (50 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
May 27, 2016 in SC
Enrollment address
10 E Hospital St
Manning, SC 29102-3153
Other Hospital Practice Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 8

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

Care Compare: Hospital

Medicare Care Compare
Listed as
McLeod Health ClarendonCCN 420109 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
McLeod Health Clarendon9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 29

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

NameRoleSinceShare
Willie E Boyd Individual Corporate OfficerBoard of Trustees Jul 12, 2016
Frances S Jones Individual Corporate OfficerBoard of Trustees Jul 12, 2016
Ashley Brady Individual Corporate OfficerBoard of Trustees Jan 1, 2021
William N Boulware Individual Corporate OfficerBoard of Trustees Jul 12, 2016
Allie E Brooks Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Shelia Rollins Individual W-2 Managing EmployeeNet Revenue MGR Mar 2, 2026
Benjamin T Zeigler Individual Corporate OfficerBoard of Trustees Jul 12, 2016
Christian Soura Individual Corporate OfficerSenior Vice President & Chief Finan Mar 31, 2025
Ronald M Fowler Individual Corporate OfficerBoard of Trustees Jul 12, 2016
Virginia L Clyburn-Ipock Individual Corporate OfficerBoard of Trustees Jun 1, 2021
Jeannette Glenn Individual Corporate OfficerBoard of Trustees Jan 1, 2021
McLeod Health Organization, Florence, SC Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 12, 2016
Samuel F Ervin Individual Corporate OfficerSenior VP & Cfo Jul 12, 2016
Jeffrey Scott Adams Individual W-2 Managing EmployeeAd; Mar 2, 2026
Raymond Clark Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Hugh S Blair Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Mary Anderson Individual Corporate OfficerBoard of Trustees Jul 12, 2016
Tracy Ray Individual Corporate OfficerBoard of Trustees Jul 12, 2016
Donna Isgett Individual Corporate OfficerPresident & Ceo Mar 1, 2021
Tarek M Bishara Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Beverly Hazelwood Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Amy Fisher Individual Corporate Officer Jun 1, 2021
Amit Vyankatesh Pande Individual Corporate OfficerBoard of Trustees Jun 1, 2021
Frank V Boulineau Individual Corporate OfficerBoard of Trustees Jul 12, 2016
Patrick Kerry Denton Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Frank J Brand Individual Corporate OfficerBoard of Trustees Jul 12, 2016
James C Smith Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Carl J Chelen Individual Corporate OfficerChief of Staff Jan 1, 2022
John R Braddy Individual Corporate OfficerBoard of Trustees Jul 12, 2016

Owners & managing parties with NPI records 7

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

Facilities with the same owner 17

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

View all 17

Practitioners & affiliated clinicians

Practitioners 17

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 17

Affiliated clinicians 301

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

View all 301

NPI Registry JSON

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

{
    "created_epoch": "1464307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587081600000",
    "number": "1205284411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 E HOSPITAL ST",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291023153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 E HOSPITAL ST",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291023153",
            "telephone_number": "803-435-8463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLEOD HEALTH CLARENDON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCLEOD HEALTH",
        "enumeration_date": "2016-05-27",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A",
        "authorized_official_last_name": "ERVIN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "FULTON",
        "authorized_official_title_or_position": "SR VICE PRESIDENT AND CFO",
        "authorized_official_telephone_number": "843-777-2910",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "42-0109",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BL0930",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AL0930",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manning, SC

Sources for this page

Verify at the official NPI Registry.