NPIMap

Organization Active NPI

McLeod Health Clarendon

  • Medicare Defined Swing Bed Hospital Unit
  • Manning, SC
National Provider Identifier
1316396377
Registry record updated Feb 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
MCLEOD HEALTH CLARENDON
Practice address
10 E Hospital St
Manning, SC 29102-3153
Phone
(803) 435-8463
NPI assigned
Jun 9, 2016
Organization subpart
Yes
Parent organization
MCLEOD HEALTHAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Samuel Fulton Ervin III
Title
Sr Vice President and Cfo
Phone
(843) 777-2910

Owners & managing parties with NPI records 9

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

Other NPIs with the same Medicare PAC ID 8

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

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

Facilities with the same owner 17

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 17

Practitioners 60

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 60

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160810000794 SC Part a Provider - Hospital 0840582656 Practice locations: Manning, SC

Hospital certification: CCN 42U109

Medicare enrollment files
Legal name
MCLEOD HEALTH CLARENDON
Organization structure
CorporationNon-profit
Incorporated
May 27, 2016 in SC
Enrollment address
10 E Hospital St
Manning, SC 29102-3153
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

All disclosed owners & managing parties 31

Medicare enrollment files

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 Jul 12, 2016
J Douglas Lynn Individual Corporate OfficerBoard of Trustees Jan 1, 2026
David Oren Atkinson Individual Corporate OfficerBoard of Trustees Jan 1, 2026
Matthew Prince Individual Corporate OfficerBoard of Trustees Jan 1, 2026
Frances S Jones Individual Corporate OfficerBoard of Trustees Jul 12, 2016
Ashley Brady Individual Corporate OfficerBoard of Trustees Jan 1, 2021
William N Boulware Individual Corporate OfficerBoard of Trustees Jul 12, 2016
Allie E Brooks Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Shelia Rollins Individual W-2 Managing EmployeeNet Rev MGR Jan 1, 2026
John M Scott Individual Corporate OfficerBoard of Trustees Jan 1, 2026
Christian Soura Individual Corporate OfficerSr VP and Cfo Jan 1, 2026
Ronald M Fowler Individual Corporate OfficerBoard of Trustees Jul 12, 2016
Dudley B. Harrington Individual Corporate OfficerVP of Business Operations Jan 1, 2026
Virginia L Clyburn-Ipock Individual Corporate OfficerBoard of Trustees Jun 1, 2021
Jeannette Glenn Individual Corporate OfficerBoard of Trustees Jan 1, 2021
McLeod Health Organization, Florence, SC Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 12, 2016 100%
Samuel F Ervin Individual Corporate OfficerSr VP & Cfo Jul 12, 2016
Jeffrey Scott Adams Individual W-2 Managing EmployeeAd; Mar 2, 2026
Marwan Kamil Elya Individual Corporate OfficerBoard of Trustees Jan 1, 2026
Hugh S Blair Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Mary Anderson Individual Corporate OfficerBoard of Trustees Jul 12, 2016
Tracy Ray Individual Corporate OfficerBoard of Trustees Jul 12, 2016
Donna Isgett Individual Corporate OfficerPresident & Ceo Jan 1, 2021
Tarek M Bishara Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Beverly Hazelwood Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Amy Fisher Individual Corporate OfficerBoard of Trustees Jun 1, 2021
Amit Vyankatesh Pande Individual Corporate OfficerBoard of Trustees Jun 1, 2021
Frank V Boulineau Individual Corporate OfficerBoard of Trustees Jul 12, 2016
Patrick Kerry Denton Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Frank J Brand Individual Corporate OfficerBoard of Trustees Jul 12, 2016
James C Smith Individual Corporate OfficerBoard of Trustees Jan 1, 2021

National Provider Directory

National Provider Directory
Tax ID family
McLeod Health Clarendon9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

10 E Hospital St
Manning, SC 29102-3153

Mailing address

10 E Hospital St
Manning, SC 29102-3153

Other identifiers 3

NPPES NPI Registry
IdentifierTypeStateIssuer
0930SBMedicaidSC
C044NFMedicaidSC
42-U109OtherSCMEDICARE

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 25, 2019.

{
    "created_epoch": "1465430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551052800000",
    "number": "1316396377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 E HOSPITAL ST",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291023153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 E HOSPITAL ST",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291023153",
            "telephone_number": "803-435-8463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLEOD HEALTH CLARENDON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCLEOD HEALTH",
        "enumeration_date": "2016-06-09",
        "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 VICE PRESIDENT AND CFO",
        "authorized_official_telephone_number": "843-777-2910",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0930SB",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "C044NF",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "42-U109",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manning, SC

Sources for this page

Verify at the official NPI Registry.