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Organization Active NPI

McLeod Physician Associates II

Doing business as McLeod Pediatrics - Dillon

  • Pediatrics Physician
  • Dillon, SC
National Provider Identifier
1346344934
Registry record updated Jun 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MCLEOD PHYSICIAN ASSOCIATES II
Doing business as
McLeod Pediatrics - Dillon
Practice address
705 N 8TH Ave
Ste 3a
Dillon, SC 29536-2549
Phone
(843) 774-6091
Fax
(843) 841-3814
NPI assigned
Sep 12, 2006
Last updated
Jun 3, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
MCLEOD HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 3, 2022

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

Authorized official

Name
Kenneth D. Beasley
Title
Senior Vice President
Phone
(843) 777-7010

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X
Family Nurse Practitioner 363LF0000X
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

705 N 8TH Ave
Ste 3a
Dillon, SC 29536-2549

Mailing address

PO Box 3239
Florence, SC 29502-3239
Phone (843) 774-6091

Other identifiers 2

IdentifierTypeStateIssuer
GP1967MedicaidSC
RHC162MedicaidSC

Other names 1

  • McLeod Pediatrics - Dillon Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061020000445 SC Part A Provider - Rural Health Clinic 8224031307 Practice locations: Dillon, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346344934. Details of each certification follow.

Rural health clinic certification: CCN 428934

Legal name
MCLEOD PHYSICIAN ASSOCIATES II
Doing business as
MCLEOD PEDIATRICS DILLON
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 1, 2000
Last certification
Dec 30, 2021
Ownership / control type
2B
Most recent change of ownership
Oct 1, 2006 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 2008 in SC
Enrollment address
705 North 8TH Ave
Suite 3a
Dillon, SC 29536-2549

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
McLeod Physician Associates II138 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

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
Kenneth L Shranko Individual Corporate OfficerVice President Jan 1, 2022
Tammy Sheffield Individual W-2 Managing EmployeeOperations Manager Jun 2, 2005
McLeod Health Organization, Florence, SC Corporation, Non-profit Operational/Managerial Control Jun 2, 2005
Samuel F Ervin Individual Corporate OfficerCfo Jun 2, 2005
Cameron Coker Individual Corporate OfficerVice President of Operations Jan 1, 2022
Kenneth Beasley Individual Corporate OfficerSenior Vice Present Jan 1, 2022
Kelly Smart Individual Corporate DirectorAvp Jan 1, 2022
Mike Payne Individual Corporate OfficerCfo Jun 2, 2005
Donna Isgett Individual Corporate OfficerCeo/President Jan 1, 2022
Jodi M Fitzsimmons Individual Corporate DirectorAvp Feb 19, 2007

Facilities with the same owner 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654214400000",
    "number": "1346344934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3239",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295023239",
            "telephone_number": "843-774-6091",
            "fax_number": "843-841-3814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 N 8TH AVE",
            "address_2": "STE 3A",
            "city": "DILLON",
            "state": "SC",
            "postal_code": "295362549",
            "telephone_number": "843-774-6091",
            "fax_number": "843-841-3814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLEOD PHYSICIAN ASSOCIATES II",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCLEOD HEALTH",
        "enumeration_date": "2006-09-12",
        "last_updated": "2022-06-03",
        "certification_date": "2022-06-03",
        "status": "A",
        "authorized_official_last_name": "BEASLEY",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "843-777-7010"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP1967",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC162",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McLeod Pediatrics - Dillon",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "McLeod Pediatrics - Dillon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dillon, SC

Sources for this page

Verify at the official NPI Registry.