NPIMap

Organization Active NPI

Genesis Healthcare, Inc.

Doing business as Genesis Healthcare Florence

  • Federally Qualified Health Center (FQHC)
  • Florence, SC
National Provider Identifier
1255305280
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GENESIS HEALTHCARE, INC.
Doing business as
Genesis Healthcare Florence
Practice address
1523 Heritage LN
Florence, SC 29505-3197
Phone
(843) 673-9992
Fax
(843) 673-9996
NPI assigned
Feb 15, 2006
Last updated
Aug 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

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

Authorized official

Name
Mr. Tony Megna
Title
Ceo
Phone
(803) 254-3676

Specialties & licenses 1

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

Addresses

Primary practice location

1523 Heritage LN
Florence, SC 29505-3197

Mailing address

8906 Two Notch Rd
Columbia, SC 29223-6366
Phone (803) 254-3676

Other names 1

  • Genesis Healthcare Florence Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110926000774 SC Part B Supplier - Clinic/Group Practice 4688869696 Receives reassigned benefits from 40 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Darlington, SC; Florence, SC; Goose Creek, SC; Lamar, SC; Olanta, SC; Walterboro, SC
O20151211001300 SC Part A Provider - Federally Qualified Health Center (FQHC) 4688869696 Practice locations: Florence, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255305280. Details of each certification follow.

Federally qualified health center certification: CCN 421029

Legal name
GENESIS HEALTHCARE, INC
Doing business as
GENESIS HEALTHCARE FLORENCE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 10, 2016
Last certification
Feb 10, 2016
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Mar 26, 2009 in SC
Enrollment address
1523 Heritage LN
Florence, SC 29505-3197

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
42D0867423Genesis Healthcare, Inc1523 Heritage Lane, Ste a, Florence, SC 29505Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Genesis Healthcare Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

1523 Heritage Ln
Florence, SC 29505
Phone (843) 673-0900

1523 Heritage Ln
Unit A
Florence, SC 29505
Phone (843) 673-9992

211 S Jones Rd
Ste B
Olanta, SC 29114
Phone (843) 393-9730

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Nathan Prabhakar Individual W-2 Managing EmployeeExecutive Finance Officer Jan 1, 2023
Tony Megna Individual Corporate OfficerCeo Oct 22, 2010
W-2 Managing EmployeeCeo Oct 22, 2010
Althia Manuel Individual W-2 Managing EmployeeClinical Revenue Cycle Officer Jan 1, 2024
Cheri Fowler Individual W-2 Managing EmployeeChief Commuinications Officer Jan 1, 2024
David Corry Individual Corporate DirectorChairperson Oct 20, 2022
Kimberly Weatherford Individual W-2 Managing EmployeeChief Operating Officer Jan 1, 2024

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Genesis Healthcare, IncDarlington, SC, CCN 421939 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Oct 4, 2010
Oct 4, 2010
Walterboro Family Care and PediatricsWalterboro, SC, CCN 421046 Federally qualified health center Operational/Managerial Control Mar 26, 2009
Mobile Health Clinic #2Columbia, SC, CCN 421112 Federally qualified health center Operational/Managerial Control Mar 26, 2009
Mobile Health Clinic #1Walterboro, SC, CCN 421114 Federally qualified health center Operational/Managerial Control Mar 26, 2009

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 33

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 33

NPI Registry JSON

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722988800000",
    "number": "1255305280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8906 TWO NOTCH RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292236366",
            "telephone_number": "803-254-3676",
            "fax_number": "803-254-3678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1523 HERITAGE LN",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295053197",
            "telephone_number": "843-673-9992",
            "fax_number": "843-673-9996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-15",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A",
        "authorized_official_last_name": "MEGNA",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-254-3676",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genesis Healthcare Florence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Florence, SC

Sources for this page

Verify at the official NPI Registry.