NPIMap

Organization Active NPI

Low Country Health Care System, Inc.

Doing business as Family Medical Center of Blackville

  • Federally Qualified Health Center (FQHC)
  • Blackville, SC
National Provider Identifier
1235225608
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LOW COUNTRY HEALTH CARE SYSTEM, INC.
Doing business as
Family Medical Center of Blackville
Practice address
130 Baker Street
Blackville, SC 29817
Phone
(803) 284-1045
Fax
(803) 284-3094
NPI assigned
Oct 5, 2006
Last updated
Jan 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Authorized official

Name
Ashley L Barnes
Title
Chief Executive Officer
Phone
(803) 632-2533

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X SC Primary

Addresses

Primary practice location

130 Baker Street
Blackville, SC 29817

Mailing address

86 Wren St
Barnwell, SC 29812-1529
Phone (803) 259-5762

Other identifiers 2

IdentifierTypeStateIssuer
F785OtherSCMEDICARE PART B PTAN
FQC077MedicaidSC

Other names 1

  • Family Medical Center of Blackville Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100607000903 SC Part A Provider - Federally Qualified Health Center (FQHC) 4284530940 Practice locations: Blackville, SC
O20160606001593 SC Part B Supplier - Clinic/Group Practice 4284530940 Receives reassigned benefits from 27 practitioners
Practice locations: Blackville, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235225608. Details of each certification follow.

Federally qualified health center certification: CCN 421891

Legal name
LOW COUNTRY HEALTH CARE SYSTEM INC
Doing business as
FAMILY MEDICAL CENTER OF BLACKVILLE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 11, 2004
Last certification
Mar 11, 2004
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Dec 8, 1997 in SC
Enrollment address
130 Baker St N
Blackville, SC 29817-2426
Related CCNs
421837

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

Other NPIs with the same Medicare PAC ID 9

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D1000024Family Medical Center of Blackville130 N Baker Street, Blackville, SC 29817ComplianceJul 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Vernie Harney Individual Corporate Director May 18, 2010
Jacob Prince Individual Corporate Director May 18, 2010
Laura Zapata Individual Corporate Director May 18, 2010
Tom Carter Individual Corporate Director May 18, 2010
Hope Rhule Individual W-2 Managing EmployeeCredentialing Specialist Nov 1, 2018
Marshal L Martin Individual Corporate Director May 18, 2010
Darainey Hudson Individual Corporate OfficerChief Complince Officer Jan 1, 2018
W-2 Managing Employee May 18, 2010
Willard Branch Individual Corporate Director May 18, 2010
Melvin Hiatt Individual Corporate Director May 18, 2010
Lee Harley Fitts Individual Corporate Director May 18, 2010

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Barnwell PediatricsBarnwell, SC, CCN 421043 Federally qualified health center Operational/Managerial Control May 1, 2014
Padgett Family PracticeBamberg, SC, CCN 421056 Federally qualified health center Operational/Managerial Control (100%) May 1, 2018
Aiken Specialty ServicesAiken, SC, CCN 421067 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2019

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1235225608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 WREN ST",
            "city": "BARNWELL",
            "state": "SC",
            "postal_code": "298121529",
            "telephone_number": "803-259-5762",
            "fax_number": "803-259-3250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 BAKER STREET",
            "city": "BLACKVILLE",
            "state": "SC",
            "postal_code": "29817",
            "telephone_number": "803-284-1045",
            "fax_number": "803-284-3094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOW COUNTRY HEALTH CARE SYSTEM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "BARNES",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "803-632-2533"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B PTAN",
            "identifier": "F785",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC077",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medical Center of Blackville",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Medical Center of Blackville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blackville, SC

Sources for this page

Verify at the official NPI Registry.