NPIMap

Organization Active NPI

Prisma Health-Midlands

Doing business as PH Family Medicine Winnsboro

  • Rural Health Clinic/Center
  • Winnsboro, SC
National Provider Identifier
1376148502
Registry record updated Dec 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PRISMA HEALTH-MIDLANDS
Doing business as
PH Family Medicine Winnsboro
Practice address
56 US Highway 321 Byp N
Winnsboro, SC 29180-7100
Phone
(803) 635-6099
Fax
(803) 635-6343
NPI assigned
Dec 4, 2020
Last updated
Dec 28, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2021

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

Authorized official

Name
Polly H. Miller
Title
SVP Finance, Enterprise Contracting
Phone
(864) 522-2286

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

56 US Highway 321 Byp N
Winnsboro, SC 29180-7100

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 455-7000

Other names 1

  • PH Family Medicine Winnsboro Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220111001638 SC Part A Provider - Rural Health Clinic 6800708330 Practice locations: Winnsboro, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376148502. Details of each certification follow.

Rural health clinic certification: CCN 423496

Legal name
PRISMA HEALTH-MIDLANDS
Doing business as
PH FAMILY MEDICINE WINNSBORO
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 22, 2022
Last certification
Apr 22, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 2019 in SC
Enrollment address
56 US Highway 321 Byp N
Winnsboro, SC 29180-7100
Related CCNs
420106

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

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Ridge Pediatric Adolesc105 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 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kristi a Lawrence Individual W-2 Managing EmployeeDirector of Provider Enrollment Apr 5, 2020
Polly H Miller Individual Corporate OfficerSVP Finance, Enterprise Contracting Mar 20, 2020
W-2 Managing EmployeeSVP Finance, Enterprise Contracting Mar 20, 2020
Prisma Health-Midlands Organization, Greenville, SC Corporation 5% Or Greater Direct Ownership Interest Apr 1, 2019 100%

Owners & managing parties with NPI records 11

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

All facility ownership & control disclosures 10

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Prisma Health Baptist HospitalColumbia, SC, CCN 420086 Hospital Operational/Managerial Control (100%)
Other		 Apr 1, 2019
Apr 1, 2019
Prisma Health Richland HospitalColumbia, SC, CCN 420018 Hospital 5% Or Greater Direct Ownership Interest (100%)
Other		 Jan 7, 2013
Jan 7, 2013
Prisma Health Richland SpringsColumbia, SC, CCN 42S018 Hospital Operational/Managerial Control
Other		 Sep 26, 1993
Sep 26, 1993
Prisma Health Baptist ParkridgeColumbia, SC, CCN 420106 Hospital Operational/Managerial Control (100%)
Other		 Jan 14, 2014
Jan 14, 2014
Prisma Health Tuomey HospitalColumbia, SC, CCN 42S086 Hospital Operational/Managerial Control
Other		 Oct 1, 1990
Oct 1, 1990
Prisma Health Tuomey HospitalSumter, SC, CCN 420070 Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2025
Prisma Health Home HealthColumbia, SC, CCN 427013 Home health agency Operational/Managerial Control (100%) Jan 1, 2007
Prisma Health Tuomey Home HealthSumter, SC, CCN 427078 Home health agency Other Jan 1, 2016
Prisma Health Tuomey HospiceSumter, SC, CCN 421509 Hospice Operational/Managerial Control
Other		 Jan 1, 2016
Jan 1, 2016
PH Family Medicine-BishopvilleBishopville, SC, CCN 423497 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2019

Owned or controlled facilities with NPI records 17

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 17

Facilities with the same owner 9

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

NPI Registry JSON

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

{
    "created_epoch": "1607040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640649600000",
    "number": "1376148502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-455-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 US HIGHWAY 321 BYP N",
            "city": "WINNSBORO",
            "state": "SC",
            "postal_code": "291807100",
            "telephone_number": "803-635-6099",
            "fax_number": "803-635-6343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISMA HEALTH-MIDLANDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-04",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "POLLY",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "SVP FINANCE, ENTERPRISE CONTRACTING",
        "authorized_official_telephone_number": "864-522-2286"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PH Family Medicine Winnsboro",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PH Family Medicine Winnsboro",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winnsboro, SC

Sources for this page

Verify at the official NPI Registry.