NPIMap

Organization Active NPI

McLeod Regional Medical Center of the Pee Dee, Inc

Doing business as McLeod Home Health

  • Home Health Agency
  • Florence, SC
National Provider Identifier
1215991682
Registry record updated Feb 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
HHA-085 Issued in SC
Legal business name
MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC
Doing business as
McLeod Home Health
Practice address
2210 Enterprise Dr
Florence, SC 29501-1109
Phone
(843) 669-3050
Fax
(843) 669-5368
NPI assigned
Apr 13, 2006
Last updated
Feb 24, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
MCLEOD HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 24, 2021

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

Authorized official

Name
Samuel Fulton Ervin III
Title
Sr VP and Cfo
Phone
(843) 777-2910

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X HHA-085 SC Primary

Addresses

Primary practice location

2210 Enterprise Dr
Florence, SC 29501-1109

Mailing address

2210 Enterprise Dr
Florence, SC 29501-1109
Phone (843) 777-3050

Other identifiers 2

IdentifierTypeStateIssuer
470573MedicaidSC
PP0001MedicaidSC

Other names 1

  • McLeod Home Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120425000292 SC Part A Provider - Home Health Agency 7416851852 Practice locations: Cheraw, SC; Dillon, SC; Florence, SC; Little River, SC; Manning, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215991682. Details of each certification follow.

Home health agency certification: CCN 427057

Legal name
MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE INC
Doing business as
MCLEOD HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 11, 1992
Last certification
Mar 6, 2018
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Feb 5, 1930 in SC
Enrollment address
2210 Enterprise Dr
Florence, SC 29501-1109
HHA Branch

Other NPIs with the same Medicare PAC ID 6

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
McLeod Home Health IncCCN 427057 · All quality measures
Overall star rating
3.5 of 5
Ownership
Non-Profit
Certified
Jun 11, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology

National Provider Directory

National Provider Directory
Tax ID family
Anesthesia Service39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

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

View all 38

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Locations

2210 Enterprise Dr
Florence, SC 29501
Phone (843) 669-3050

Ownership & related parties

All disclosed owners & managing parties 27

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 Jan 1, 2018
Steven R Ross Individual Corporate OfficerBoard of Directors Jan 1, 2018
Frances S Jones Individual Corporate OfficerBoard of Trustees Jan 1, 2018
Ashley Brady Individual Corporate OfficerBoard of Trustees Jan 1, 2018
William N Boulware Individual Corporate OfficerBoard of Trustees Jan 1, 2018
Allie E Brooks Individual Corporate OfficerBoard of Trustees Oct 15, 2019
Benjamin T Zeigler Individual Corporate OfficerBoard of Trustees Jan 1, 2018
Mark a Reynolds Individual Corporate OfficerBoard of Trustees Jan 1, 2018
Ronald M Fowler Individual Corporate OfficerBoard of Trustees Jan 1, 2018
Dudley B. Harrington Individual Corporate OfficerVP of Business Operations Jan 1, 2018
Jeannette Glenn Individual Corporate OfficerBoard of Trustees Jan 1, 2018
McLeod Health Organization, Florence, SC Corporation 5% Or Greater Direct Ownership Interest Jul 3, 2003 100%
Samuel F Ervin Individual Operational/Managerial Control Nov 10, 2011
Raymond Clark Individual Corporate OfficerBoard of Trustees Oct 15, 2019
Hugh S Blair Individual Corporate OfficerBoard of Trustees Jan 1, 2018
Mary Anderson Individual Corporate OfficerBoard of Trustees Jan 1, 2018
Tracy Ray Individual Corporate OfficerBoard of Trustees Jan 1, 2018
Donna Isgett Individual Corporate OfficerPresident and Ceo Mar 1, 2021
Tarek M Bishara Individual Corporate OfficerBoard of Trustees Jan 1, 2018
Beverly Hazelwood Individual Corporate OfficerBoard of Trustees Jan 1, 2018
Frank V Boulineau Individual Corporate OfficerBoard of Trustees Jan 1, 2018
Denise Melton Individual W-2 Managing EmployeeAdministrator of Home Health Jan 1, 2018
Michael R Rose Individual Corporate OfficerBoard of Trustees Jan 1, 2018
Patrick Kerry Denton Individual Corporate OfficerBoard of Trustees Jan 1, 2018
Frank J Brand Individual Corporate OfficerBoard of Trustees Jan 1, 2018
James C Smith Individual Corporate OfficerBoard of Trustees Oct 15, 2019
John R Braddy Individual Corporate OfficerBoard of Trustees Jan 1, 2018

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Hospice of the Pee DeeFlorence, SC, CCN 421516 Hospice 5% Or Greater Direct Ownership Interest Jul 3, 2003

Owned or controlled facilities with NPI records 1

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

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

Affiliated clinicians 126

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

View all 126

NPI Registry JSON

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614124800000",
    "number": "1215991682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2210 ENTERPRISE DR",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295011109",
            "telephone_number": "843-777-3050",
            "fax_number": "843-777-5368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2210 ENTERPRISE DR",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295011109",
            "telephone_number": "843-669-3050",
            "fax_number": "843-669-5368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLEOD REGIONAL MEDICAL CENTER OF THE PEE DEE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCLEOD HEALTH",
        "enumeration_date": "2006-04-13",
        "last_updated": "2021-02-24",
        "certification_date": "2021-02-24",
        "status": "A",
        "authorized_official_last_name": "ERVIN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "FULTON",
        "authorized_official_title_or_position": "SR VP AND CFO",
        "authorized_official_telephone_number": "843-777-2910",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "SC",
            "license": "HHA-085",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "470573",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PP0001",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McLeod Home Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "McLeod Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Florence, SC

Sources for this page

Verify at the official NPI Registry.