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McLeod Physician Associates II

Organization Active NPI Pediatrics Physician · Dillon, SC

NPI 1346344934 · NPPES record last updated Jun 3, 2022

Key facts

NPI
1346344934
Entity type
Organization (NPI type 2)
Primary specialty
Pediatrics Physician 208000000X
Legal business name
MCLEOD PHYSICIAN ASSOCIATES II
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
Organization subpart
Yes
Parent organization (as reported)
MCLEOD HEALTH

Authorized official

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

Other NPIs with the same Medicare PAC ID 1

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

Corporate family (same tax ID) 24

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

Facilities with the same owner 17

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

Practitioners 541

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

View all 541

Medicare participation

Medicare fee-for-service enrollment
Enrolled in SC

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
Corporation · Non-profit
Incorporated
Oct 1, 2008 in SC
Enrollment address
705 North 8TH Ave
Suite 3a
Dillon, SC 29536-2549

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 Officer
Vice President		 Jan 1, 2022
Tammy Sheffield
Individual 		W-2 Managing Employee
Operations Manager		 Jun 2, 2005
McLeod Health
Organization · Florence, SC
Corporation, Non-profit 		Operational/Managerial Control Jun 2, 2005
Samuel F Ervin
Individual 		Corporate Officer
Cfo		 Jun 2, 2005
Cameron Coker
Individual 		Corporate Officer
Vice President of Operations		 Jan 1, 2022
Kenneth Beasley
Individual 		Corporate Officer
Senior Vice Present		 Jan 1, 2022
Kelly Smart
Individual 		Corporate Director
Avp		 Jan 1, 2022
Mike Payne
Individual 		Corporate Officer
Cfo		 Jun 2, 2005
Donna Isgett
Individual 		Corporate Officer
Ceo/President		 Jan 1, 2022
Jodi M Fitzsimmons
Individual 		Corporate Director
Avp		 Feb 19, 2007

Medicare enrollment records

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

National Provider Directory

Tax ID family
McLeod Physician Associates II (138 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208000000X Yes
Rural Health Clinic/Center 261QR1300X
Family Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363LF0000X

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

IdentifierTypeStateIssuer
RHC162MedicaidSC
GP1967MedicaidSC

Other names

  • McLeod Pediatrics - Dillon Doing business as

Other providers in Dillon, SC

All providers in Dillon, SC · Pediatrics Physician in South Carolina

Sources for this page

Verify at the official NPI Registry.