Regenesis Organization Community Health Center
Organization Active NPI Federally Qualified Health Center (FQHC) · Spartanburg, SC
NPI 1457061087 · NPPES record last updated Jan 3, 2025
Key facts
- NPI
- 1457061087
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- REGENESIS ORGANIZATION COMMUNITY HEALTH CENTER
- Practice address
- 945 E Main St Ste a
Spartanburg, SC 29302-2119 - Phone
- (864) 582-2411
- NPI assigned
- Dec 5, 2022
- Organization subpart
- No
Authorized official
- Name
- Marlon Hunter
- Title
- Ceo
- Phone
- (864) 594-0190
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 10
Practitioners 94
-
Tamika Nicole Murphy, APRN
-
Octavia Amaechi, MD
-
Stephen Michael Behan, PA-C
-
Anita Charie Belue, FNP-C
-
Evodia Jeanette Godfrey, APRN
-
Jordan Ashley Grice, APRN
-
Jason Hennessy, FNP-BC
-
Martrell Denise Kelly John, LISW-CP
-
Donna Fossett Knight, APRN
-
Jessica Nicole Mills, APRN
-
Priscilla Parker, LPC
-
Brad Edward Peterson, LISW-CP
-
Kelli Anne Rosson, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SC
Federally qualified health center certification: CCN 421100
- Legal name
- REGENESIS ORGANIZATION COMMUNITY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jun 14, 2024
- Last certification
- Jun 14, 2024
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Proprietary
- Enrollment address
- 954 E Main St
Ste a
Spartanburg, SC 29302-2148
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Marlon Hunter |
Corporate Officer | Aug 1, 2018 | |
| Corporate Director | Aug 1, 2018 | ||
| W-2 Managing Employee | Aug 1, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240613002781 | SC | Part a Provider - Federally Qualified Health Center (FQHC) | 8022928001 | Practice locations: Spartanburg, SC |
| O20251010000966 | SC | Part B Supplier - Clinic/Group Practice | 8022928001 |
Receives reassigned benefits from 1 practitioner Practice locations: Spartanburg, SC |
National Provider Directory
- Tax ID family
- Regenesis Organization
Locations
1663 E Main St
Duncan, SC 29334
Phone (846) 416-7933
954 E Main St
Ste A
Spartanburg, SC 29302
945 E Main St
Ste A
Spartanburg, SC 29302
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | |||
| Family Medicine Physician |
207Q00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
945 E Main St Ste a
Spartanburg, SC 29302-2119
Mailing address
PO Box 5158
Spartanburg, SC 29304-5158
Phone (864) 582-2411
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194710426 | Other | NPI |
Other names
- REGENESIS HEALTH CARE
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | credentialing@myrhc.org | Direct | REGENESIS ORGANIZATION COMMUNITY HEALTH CENTER |
Other providers in Spartanburg, SC
- Reflections Therapy Group LLC
- Regenerative Health 360 LLC
- Regenesis Organization Community Health Center
- Regenesis Organization Community Health Center
- Regenesis Organization Community Health Center
- Regenesis Organization Community Health Center
- Regenesis Organization Community Health Center
- Regenesis Organization Community Health Center
- Regenesis Organization Community Health Center
- Regenesis Organization Community Health Center
All providers in Spartanburg, SC · Federally Qualified Health Center (FQHC) in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.