NPIMap

Organization Active NPI

Carolina Health Centers, Inc.

Doing business as Carolina Health Centers at Greenwood MHC

  • Federally Qualified Health Center (FQHC)
  • Greenwood, SC
National Provider Identifier
1205511482
Registry record updated Jan 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CAROLINA HEALTH CENTERS, INC.
Doing business as
Carolina Health Centers at Greenwood MHC
Practice address
1547 Parkway Ste 200, RM 306, 302
Greenwood, SC 29646-4081
Phone
(864) 330-8240
Fax
(864) 943-1120
NPI assigned
Jun 16, 2023
Last updated
Jan 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2024

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

Authorized official

Name
Lisa Y Gilmer
Title
Revenue Cycle Manager
Phone
(864) 941-8121

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1547 Parkway Ste 200, RM 306, 302
Greenwood, SC 29646-4081

Mailing address

313 Main St Ste B
Greenwood, SC 29646-2757
Phone (864) 330-8240

Other names 1

  • Carolina Health Centers at Greenwood MHC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240619002139 SC Part A Provider - Federally Qualified Health Center (FQHC) 5496707804 Practice locations: Greenwood, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205511482. Details of each certification follow.

Federally qualified health center certification: CCN 421105

Legal name
CAROLINA HEALTH CENTERS INC
Doing business as
CAROLINA HEALTH CENTERS AT GREENWOOD MHC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 20, 2024
Last certification
Aug 20, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 27, 1977 in SC
Enrollment address
1547 Parkway
Ste 200
Greenwood, SC 29646-4081

Other NPIs with the same Medicare PAC ID 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Carolina Health Centers Inc12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Christopher Scott Clem Individual Corporate OfficerCfo Jun 16, 2025
W-2 Managing EmployeeCfo Jun 16, 2025
Bonnie Ramage Individual Corporate Director Sep 26, 2022
Abby Banks Individual Corporate Director Mar 27, 2017
Kimberly Kapetanakos Individual Corporate Director Mar 27, 2017
Donna Hutchinson Individual Corporate Director Oct 28, 2019
Miriam Ferguson Individual Corporate DirectorCeo Jul 14, 2025 100%
Johanna Bishop Individual Corporate Director Jun 28, 2021
Mario Luna Individual Corporate Director Sep 24, 2014
Rodriguis Brown Individual Corporate Director Dec 7, 2021
Gail D Ferguson Individual Corporate Director Jul 1, 1994
John Britt Individual Corporate Director Aug 1, 1992
Julian Gale Individual Corporate Director Sep 26, 2022
Sojourner Jennings Individual Corporate Director Dec 7, 2021
Paul Grogan Individual Corporate Officer Aug 6, 2012
David Otabor Individual Corporate Director Sep 26, 2022
Locke Eugene Simons Individual Corporate Officer Apr 9, 2007

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1686873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706054400000",
    "number": "1205511482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 MAIN ST STE B",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296462757",
            "telephone_number": "864-330-8240",
            "fax_number": "864-943-1120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1547 PARKWAY STE 200, RM 306, 302",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296464081",
            "telephone_number": "864-330-8240",
            "fax_number": "864-943-1120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA HEALTH CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-16",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A",
        "authorized_official_last_name": "GILMER",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "864-941-8121"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolina Health Centers at Greenwood MHC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Carolina Health Centers at Greenwood MHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenwood, SC

Sources for this page

Verify at the official NPI Registry.