NPIMap

Organization Active NPI

Lake City Family Medicine LLC

  • Primary Care Clinic/Center
  • Lake City, SC
National Provider Identifier
1396969002
Registry record updated Mar 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
LAKE CITY FAMILY MEDICINE LLC
Practice address
901 N. Matthews Rd.
Lake City, SC 29560
Phone
(843) 374-8380
NPI assigned
Apr 12, 2007
Last updated
Mar 16, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2009

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

Authorized official

Name
Dr. Morris Edward Brown III, MDNPI 1801992599
Title
Owner
Phone
(843) 374-8380

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X SC Primary
Rural Health Clinic/Center 261QR1300X 17100 SC

Addresses

Primary practice location

901 N. Matthews Rd.
Lake City, SC 29560

Mailing address

901 N. Matthews Rd.
Lake City, SC 29560
Phone (843) 374-8380

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20070530000463 SC Part A Provider - Rural Health Clinic 0547368441 Practice locations: Lake City, SC
O20070628000620 SC Part B Supplier - Clinic/Group Practice 0547368441 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Kingstree, SC; Lake City, SC
O20100930032222 SC DME Supplier - Physician - Family Practice 0547368441 Practice locations: Lake City, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396969002. Details of each certification follow.

Rural health clinic certification: CCN 428988

Legal name
LAKE CITY FAMILY MEDICINE LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 28, 2007
Last certification
Mar 7, 2023
Ownership / control type
1A
Organization structure
CorporationProprietary
Incorporated
Jan 27, 2006 in SC
Enrollment address
901 N Matthews Rd
Lake City, SC 29560-7024

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Morris E Brown Individual 5% Or Greater Direct Ownership InterestOwner Jan 27, 2006 100%
W-2 Managing Employee Jan 27, 2006

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237161600000",
    "number": "1396969002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 N. MATTHEWS RD.",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "29560",
            "telephone_number": "843-374-8380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 N. MATTHEWS RD.",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "29560",
            "telephone_number": "843-374-8380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CITY FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2009-03-16",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "MORRIS",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-374-8380",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "SC",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "SC",
            "license": "17100",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake City, SC

Sources for this page

Verify at the official NPI Registry.