NPIMap

Organization Active NPI

Fetter Health Care Network Inc

Doing business as Fetter Health Care Network-Hollywood Site

  • Federally Qualified Health Center (FQHC)
  • Hollywood, SC
National Provider Identifier
1386792976
Registry record updated Oct 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FETTER HEALTH CARE NETWORK INC
Doing business as
Fetter Health Care Network-Hollywood Site
Practice address
5225 Highway 165
Hollywood, SC 29449-6144
Phone
(843) 889-2272
Fax
(843) 889-2274
NPI assigned
Jan 8, 2007
Last updated
Oct 18, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2016

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

Authorized official

Name
Mrs. Aretha Jones
Title
Executive Director
Phone
(843) 722-4112

Specialties & licenses 1

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

Addresses

Primary practice location

5225 Highway 165
Hollywood, SC 29449-6144

Mailing address

51 Nassau Street
Charleston, SC 29403-5513
Phone (843) 722-4112

Other names 1

  • Fetter Health Care Network-Hollywood Site Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070507000192 SC Part B Supplier - Clinic/Group Practice 9032215199 Receives reassigned benefits from 91 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Walterboro, SC; Cross, SC; Summerville, SC; North Charleston, SC; N Charleston, SC; Charleston, SC; Johns Island, SC; Hollywood, SC
O20080819000386 SC Part A Provider - Federally Qualified Health Center (FQHC) 9032215199 Practice locations: Hollywood, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386792976. Details of each certification follow.

Federally qualified health center certification: CCN 421856

Legal name
FETTER HEALTH CARE NETWORK INC
Doing business as
HOLLYWOOD FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 3, 1998
Last certification
Aug 3, 1998
Ownership / control type
For profit – partnership
Most recent change of ownership
Apr 1, 2008 (2 total)
Organization structure
CorporationNon-profit
Incorporated
Apr 8, 1975 in SC
Enrollment address
5225 Highway 165
Hollywood, SC 29449-6144

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Franklin C Fetter Family Health Center Inc38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

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

View all 37

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Shantae J Jenkins Individual Corporate OfficerBoard Member Jan 1, 2014
W-2 Managing EmployeeChief Medical Officer Aug 31, 2015
Alison McCullough Individual Corporate OfficerBoard of Directors Jan 1, 2023
Nicholas P Shungu Individual Corporate OfficerBoard of Directors Jan 1, 2023
Darlene E Wright Individual Corporate OfficerBoard Member Jan 1, 2014
Enid B Jenkins Individual Corporate OfficerBoard Member Jan 1, 2014
Shelli D Quenga Individual Corporate OfficerBoard of Directors Jan 1, 2023
Aretha Powers Individual Corporate DirectorCeo Apr 11, 2016
W-2 Managing EmployeeCeo Apr 11, 2016
Sonya B Jones Individual Corporate OfficerBoard Member Jan 1, 2014
Deborah C Williamson Individual Corporate OfficerBoard Member Jan 1, 2014
Phalarma Freeman Individual Corporate OfficerBoard Member Jan 1, 2014
Catherine Oconnor Durham Individual Corporate OfficerBoard of Directors Jan 1, 2023

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Fetter Health Care Network IncCharleston, SC, CCN 421044 Federally qualified health center Operational/Managerial Control (100%) Sep 18, 2014

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476748800000",
    "number": "1386792976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 NASSAU STREET",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294035513",
            "telephone_number": "843-722-4112",
            "fax_number": "843-577-8960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5225 HIGHWAY 165",
            "city": "HOLLYWOOD",
            "state": "SC",
            "postal_code": "294496144",
            "telephone_number": "843-889-2272",
            "fax_number": "843-889-2274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FETTER HEALTH CARE NETWORK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2016-10-18",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "ARETHA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "843-722-4112",
        "authorized_official_name_prefix": "Mrs."
    },
    "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": "Fetter Health Care Network-Hollywood Site",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hollywood, SC

Sources for this page

Verify at the official NPI Registry.