NPIMap

Organization Active NPI

McLeod Loris Seacoast Hospital

Doing business as Loris Community Hospital

  • General Acute Care Hospital
  • Loris, SC
National Provider Identifier
1306123344
Registry record updated Feb 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
HTL033 Issued in SC
Legal business name
MCLEOD LORIS SEACOAST HOSPITAL
Doing business as
Loris Community Hospital
Practice address
3655 Mitchell St
Loris, SC 29569-2827
Phone
(843) 716-7000
Fax
(843) 716-7195
NPI assigned
Nov 4, 2011
Last updated
Feb 25, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
MCLEOD HEALTH, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 25, 2019

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 VP and Cfo
Phone
(843) 777-2910

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X HTL033 SC Primary

Addresses

Primary practice location

3655 Mitchell St
Loris, SC 29569-2827

Mailing address

3655 Mitchell St
Box 690001
Loris, SC 29569-2827
Phone (843) 716-7000

Other identifiers 3

IdentifierTypeStateIssuer
BHTL33MedicaidSC
AHTL33MedicaidSC
4200105MedicaidNC

Other names 1

  • Loris Community Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111216000668 SC Part A Provider - Hospital 9133394398 Practice locations: Little River, SC; Loris, SC; Myrtle Beach, SC; North Myrtle Beach, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306123344. Details of each certification follow.

Hospital certification: CCN 420105

Legal name
MCLEOD LORIS SEACOAST HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jan 13, 2012
Last certification
Oct 22, 2019
Beds
105
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Oct 3, 2011 in SC
Enrollment address
3655 Mitchell St
Loris, SC 29569-2827
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
McLeod Loris HospitalCCN 420105 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
McLeod Loris Seacoast Hospital2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

3655 Mitchell St
#690001
Loris, SC 29569
Phone (843) 716-7000

101 McLeod Health Blvd
Ste 101
Myrtle Beach, SC 29579
Phone (843) 646-8001

Ownership & related parties

All disclosed owners & managing parties 31

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 Oct 1, 2019
Monica a Vehige Individual W-2 Managing EmployeeAdministrator McLeod Seacoast Mar 20, 2017
Frances S Jones Individual Corporate OfficerBoard of Trustees Oct 1, 2019
Ashley Brady Individual Corporate OfficerBoard of Trustees Oct 1, 2019
Michael Montgomery Individual W-2 Managing EmployeeAdministrator McLeod Loris Jan 1, 2018
William N Boulware Individual Corporate OfficerBoard of Trustees Oct 1, 2019
Allie E Brooks Individual Corporate OfficerBoard of Trustees Oct 1, 2019
Shelia Rollins Individual W-2 Managing EmployeeNet Revenue MGR Jan 1, 2025
Benjamin T Zeigler Individual Corporate OfficerBoard of Trustees Oct 1, 2019
Christian Soura Individual Corporate OfficerSenior VP and Cfo Apr 1, 2025
Ronald M Fowler Individual Corporate OfficerBoard of Trustees Oct 1, 2019
Dudley B. Harrington Individual Corporate OfficerVice President of Business Operatio Oct 31, 2016 100%
Virginia L Clyburn-Ipock Individual Corporate OfficerBoard of Trustees Jun 1, 2021
Jeannette Glenn Individual Corporate OfficerBoard of Trustees Oct 1, 2019
McLeod Health Organization, Florence, SC Corporation 5% Or Greater Direct Ownership Interest Jan 1, 2012
Samuel F Ervin Individual Operational/Managerial Control Jan 1, 2012
Raymond Clark Individual Corporate OfficerBoard of Trustees Oct 1, 2019
Hugh S Blair Individual Corporate OfficerBoard of Trustees Oct 1, 2019
Mary Anderson Individual Corporate OfficerBoard of Trustees Oct 1, 2019
Tracy Ray Individual Corporate OfficerBoard of Trustees Oct 1, 2019
Donna Isgett Individual Corporate OfficerPresident and Ceo Mar 1, 2021
Tarek M Bishara Individual Corporate OfficerBoard of Trustees Oct 1, 2019
Beverly Hazelwood Individual Corporate OfficerBoard of Trustees Oct 1, 2019
Amy Fisher Individual Corporate OfficerBoard of Trustees Jun 1, 2021
Amit Vyankatesh Pande Individual Corporate Officer Jun 1, 2021
Frank V Boulineau Individual Corporate OfficerBoard of Trustees Oct 1, 2019
Patrick Kerry Denton Individual Corporate OfficerBoard of Trustees Oct 1, 2019
Frank J Brand Individual Corporate OfficerBoard of Trustees Oct 1, 2019
James C Smith Individual Corporate OfficerBoard of Trustees Oct 1, 2019
Carl J Chelen Individual Corporate OfficerChief of Staff Jan 1, 2022
John R Braddy Individual Corporate OfficerBoard of Trustees Oct 1, 2019

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 27

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 27

Affiliated clinicians 835

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

View all 835

NPI Registry JSON

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

{
    "created_epoch": "1320364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551052800000",
    "number": "1306123344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3655 MITCHELL ST",
            "address_2": "BOX 690001",
            "city": "LORIS",
            "state": "SC",
            "postal_code": "295692827",
            "telephone_number": "843-716-7000",
            "fax_number": "843-716-7195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3655 MITCHELL ST",
            "city": "LORIS",
            "state": "SC",
            "postal_code": "295692827",
            "telephone_number": "843-716-7000",
            "fax_number": "843-716-7195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLEOD LORIS SEACOAST HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCLEOD HEALTH, INC.",
        "enumeration_date": "2011-11-04",
        "last_updated": "2019-02-25",
        "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_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "SC",
            "license": "HTL033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BHTL33",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AHTL33",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4200105",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Loris Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Loris Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Loris, SC

Sources for this page

Verify at the official NPI Registry.