NPIMap

Organization Active NPI

Edisto Regional Health Services Inc.

Doing business as RMC Primary Care St. Matthews

  • Rural Health Clinic/Center
  • St Matthews, SC
National Provider Identifier
1396976700
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
EDISTO REGIONAL HEALTH SERVICES INC.
Doing business as
RMC Primary Care St. Matthews
Practice address
651A Harry C Raysor Dr
St Matthews, SC 29135-1487
Phone
(803) 395-3755
Fax
(803) 874-3905
NPI assigned
Aug 3, 2009
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
EDISTO REGIONAL HEALTH SERVICES INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Christal Leann Fulmer
Title
Revenue Integrity Manager
Phone
(803) 395-4248

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Rural Health Clinic/Center 261QR1300X SC Primary

Addresses

Primary practice location

651A Harry C Raysor Dr
St Matthews, SC 29135-1487

Mailing address

PO Box 1245
Orangeburg, SC 29116-1245
Phone (803) 395-4497

Other identifiers 6

IdentifierTypeStateIssuer
017OtherSCBCBS
CK8831OtherSCRRMEDICARE
015OtherSCBLUECHOICE
015OtherSCTRICARE
GP5396MedicaidSC
CN8991OtherSCRRMEDICARE

Other names 1

  • RMC Primary Care St. Matthews Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040810000307 SC Part B Supplier - Clinic/Group Practice 4981693447 Receives reassigned benefits from 41 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bowman, SC; Bamberg, SC; Santee, SC; Saint Matthews, SC; Orangeburg, SC; Holly Hill, SC; Branchville, SC

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory
Part of
SC Orthopaedic Institute

Practitioners & affiliated clinicians

Practitioners 5

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": "1249257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1396976700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1245",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291161245",
            "telephone_number": "803-395-4497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651A HARRY C RAYSOR DR",
            "city": "ST MATTHEWS",
            "state": "SC",
            "postal_code": "291351487",
            "telephone_number": "803-395-3755",
            "fax_number": "803-874-3905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDISTO REGIONAL HEALTH SERVICES INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EDISTO REGIONAL HEALTH SERVICES INC.",
        "enumeration_date": "2009-08-03",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "FULMER",
        "authorized_official_first_name": "CHRISTAL",
        "authorized_official_middle_name": "LEANN",
        "authorized_official_title_or_position": "REVENUE INTEGRITY MANAGER",
        "authorized_official_telephone_number": "803-395-4248"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "017",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMEDICARE",
            "identifier": "CK8831",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECHOICE",
            "identifier": "015",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "015",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP5396",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMEDICARE",
            "identifier": "CN8991",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RMC Primary Care St. Matthews",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "RMC Primary Care St. Matthews",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Matthews, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.