NPIMap

Organization Active NPI

Regenesis Organization Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Spartanburg, SC
National Provider Identifier
1457745952
Registry record updated May 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
REGENESIS ORGANIZATION COMMUNITY HEALTH CENTER
Practice address
460 Langdon St.
Spartanburg, SC 29302-1631
Phone
(864) 582-2817
Fax
(864) 582-2829
NPI assigned
Mar 23, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2020

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

Authorized official

Name
Marlon Hunter
Title
Ceo
Phone
(864) 582-2817

Specialties & licenses 1

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

Addresses

Primary practice location

460 Langdon St.
Spartanburg, SC 29302-1631

Mailing address

P.O. Box 5158
Spartanburg, SC 29304-5158
Phone (864) 582-2817

Other identifiers 1

IdentifierTypeStateIssuer
FQC211MedicaidSC

Other names 1

  • ReGenesis Health Care Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150612002468 SC Part A Provider - Federally Qualified Health Center (FQHC) 8022928001 Practice locations: Spartanburg, SC
O20170127000968 SC Part B Supplier - Clinic/Group Practice 8022928001 Receives reassigned benefits from 73 practitioners
Practice locations: Spartanburg, SC

Federally qualified health center certification: CCN 421045

Legal name
REGENESIS ORGANIZATION COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 13, 2015
Last certification
Jun 13, 2015
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
in SC
Enrollment address
460 Langdon Street
Spartanburg, SC 29302-1631

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Marlon Hunter Individual Corporate OfficerCeo Aug 1, 2018 100%
Cheryl a Rivers Individual W-2 Managing EmployeeBilling Director Nov 13, 2012

Practitioners & affiliated clinicians

Practitioners 105

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 105

NPI Registry JSON

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

{
    "created_epoch": "1427068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589760000000",
    "number": "1457745952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 5158",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293045158",
            "telephone_number": "864-582-2817",
            "fax_number": "864-582-2829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 LANGDON ST.",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293021631",
            "telephone_number": "864-582-2817",
            "fax_number": "864-582-2829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENESIS ORGANIZATION COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-23",
        "last_updated": "2020-05-18",
        "certification_date": "2020-05-18",
        "status": "A",
        "authorized_official_last_name": "HUNTER",
        "authorized_official_first_name": "MARLON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "864-582-2817"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC211",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ReGenesis Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spartanburg, SC

Sources for this page

Verify at the official NPI Registry.