NPIMap

Organization Active NPI

Low Country Health Care System, Inc

Doing business as Bamberg Specialty Services

  • Federally Qualified Health Center (FQHC)
  • Bamberg, SC
National Provider Identifier
1306378310
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
Bamberg Specialty Services
Practice address
185 McGee St
Bamberg, SC 29003-1154
Phone
(803) 956-6100
Fax
(803) 245-4338
NPI assigned
Mar 29, 2017
Last updated
Jan 11, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
LOW COUNTRY HEALTH CARE SYSTEM, INCAs reported in NPPES

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
Darainey Hudson
Title
HR Director
Phone
(803) 632-2533

Specialties & licenses 1

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

Addresses

Primary practice location

185 McGee St
Bamberg, SC 29003-1154

Mailing address

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

Other names 1

  • Bamberg Specialty Services Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190509002326 SC Part A Provider - Federally Qualified Health Center (FQHC) 4284530940 Practice locations: Bamberg, SC
O20200107003426 SC Part B Supplier - Clinic/Group Practice 4284530940 Receives reassigned benefits from 33 practitioners
Practice locations: Bamberg, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306378310. Details of each certification follow.

Federally qualified health center certification: CCN 421054

Legal name
LOW COUNTRY HEALTH CARE SYSTEM INC
Doing business as
EARLY INTERVENTION SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 9, 2018
Last certification
Apr 9, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 8, 1997 in SC
Enrollment address
185 McGee St
Bamberg, SC 29003-1154

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
42D2129194Bamberg Specialty Services185 McGee Street, Bamberg, SC 29003Provider-performed microscopyApr 13, 2027

National Provider Directory

National Provider Directory
Part of
Lowcountry Health Care

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
Evelyn R Coker Individual Corporate DirectorBoard Member-Chair Jan 1, 2013
Ashley L Barnes Individual Corporate OfficerChief Executive Officer Jul 31, 1989 100%
Hope Rhule Individual Corporate OfficerChief Executive Officer Oct 11, 2011 100%
W-2 Managing Employee Jan 23, 2018
Marshal L Martin Individual Corporate DirectorBoard Chairman Jan 1, 2010
Darainey Hudson Individual W-2 Managing EmployeeChief Compliance Officer Jul 31, 1989 75%
Daniel L Packer Individual Corporate DirectorBoard Member-Treasurer Jan 1, 2013

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 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1306378310",
    "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": "185 MCGEE ST",
            "city": "BAMBERG",
            "state": "SC",
            "postal_code": "290031154",
            "telephone_number": "803-956-6100",
            "fax_number": "803-245-4338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOW COUNTRY HEALTH CARE SYSTEM, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LOW COUNTRY HEALTH CARE SYSTEM, INC",
        "enumeration_date": "2017-03-29",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "HUDSON",
        "authorized_official_first_name": "DARAINEY",
        "authorized_official_title_or_position": "HR DIRECTOR",
        "authorized_official_telephone_number": "803-632-2533"
    },
    "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": "Bamberg Specialty Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bamberg, SC

Sources for this page

Verify at the official NPI Registry.