Walterboro Adult and Pediatric Medicine,LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

WALTERBORO ADULT AND PEDIATRIC MEDICINE,LLC

Practice address

447 Spruce St
Walterboro, SC 29488-2766

Phone

(843) 549-6331

Fax

(843) 549-6332

NPI assigned

Dec 21, 2005

Organization subpart

No

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

Authorized official

Name

John Glenn Creel, M.D.NPI 1992708309

Title

Ceo

Phone

(843) 549-6331

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467438499. Details of each certification follow.

• CCN 423804 Rural health clinic · Active · Details

Rural health clinic certification: CCN 423804

Legal name

WALTERBORO ADULT AND PEDIATRIC MEDICINE,LLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Apr 27, 2009

Last certification

Oct 21, 2021

Ownership / control type

1B

Organization structure

LLCProprietary

Enrollment address

447 Spruce St
Walterboro, SC 29488-2766

Locations

Interoperability endpoints

• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.73267

All disclosed owners & managing parties 3

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

Owners & managing parties with NPI records 1

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

• John Glenn Creel, M.D.

  • Family Medicine Physician
  • Walterboro, SC
  • NPI 1992708309

  5% Or Greater Direct Ownership Interest

  CMS ownership

Practitioners 1

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.

• John Glenn Creel, M.D.

  • Family Medicine Physician
  • Walterboro, SC
  • NPI 1992708309
  Authorized official Same address or phone

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775606400000",
    "number": "1467438499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "447 SPRUCE ST",
            "city": "WALTERBORO",
            "state": "SC",
            "postal_code": "294882766",
            "telephone_number": "843-549-6331",
            "fax_number": "843-549-6332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "447 SPRUCE ST",
            "city": "WALTERBORO",
            "state": "SC",
            "postal_code": "294882766",
            "telephone_number": "843-549-6331",
            "fax_number": "843-549-6332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALTERBORO ADULT AND PEDIATRIC MEDICINE,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-21",
        "last_updated": "2026-04-08",
        "certification_date": "2026-04-08",
        "status": "A",
        "authorized_official_last_name": "CREEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "GLENN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-549-6331",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  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": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3911",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores East, LP (Vision center 30-1358)
• Walgreen Co (Walgreens #9284)
• Walgreen Co (Rite Aid)
• Juliette Walker, M.D.
• Walterboro Adult & Pediatric Medicine, LLC
• Walterboro Community Hospital, Inc. (HCA Healthcare Colleton Hospital)
• Walterboro Community Hospital, Inc. (HCA Healthcare Colleton Hospital)
• Walterboro Community Hospital, Inc. (HCA Healthcare Colleton Hospital)
• Walterboro Community Hospital, Inc. (HCA Healthcare Colleton Hospital)
• Walterboro Community Hospital, Inc. (Colleton Medical Center)

• Rural Health Clinic/Center in Walterboro, SC
• Providers in Walterboro, SC by specialty
• Rural Health Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.