Active NPI
Grove Park Pharmacy Hospice Care
- Community Based Hospice Care Agency
- Orangeburg, SC
National Provider Identifier
1467760058
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- License
- HPC0155
- Legal business name
- GROVE PARK PHARMACY HOSPICE CARE
- Practice address
- 1324 Chestnut Street
Orangeburg, SC 29115 - Phone
- (803) 536-0007
- NPI assigned
- Sep 17, 2010
- Last updated
- Jul 29, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Charles P Thompson Jr.
- Title
- Owner
- Phone
- (803) 536-0007
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | HPC0155 | SC | Primary |
Addresses
Primary practice location
1324 Chestnut Street
Orangeburg, SC 29115
Mailing address
PO Box 701
Orangeburg, SC 29116-0701
Phone (803) 536-0007
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HSP118 | Medicaid | SC | |
| HPC0155 | Other | SC | HOSPICE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101020000312 | SC | Part A Provider - Hospice | 2961695127 | Practice locations: Orangeburg, SC |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1467760058. Details of each certification follow.
Hospice certification: CCN 421601
- Legal name
- GROVE PARK PHARMACY HOSPICE CARE, LLC
- Doing business as
- GROVE PARK PHARMACY HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Jan 21, 2011
- Last certification
- Feb 18, 2021
- Ownership / control type
- Proprietary - Other
- Organization structure
- LLC
- Incorporated
- Aug 3, 2010 in SC
- Enrollment address
- 1324 Chestnut Street
Orangeburg, SC 29115-2455
Care Compare: Hospice
Medicare Care Compare- Listed as
- Grove Park Pharmacy Hospice
- Ownership
- For-Profit
- Certified
- Jan 21, 2011
- Medicare certification status
- Active
National Provider Directory
National Provider DirectoryOwnership & 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.
| Name | Role | Since | Share |
|---|---|---|---|
| Debbie Hare | W-2 Managing Employee | Aug 18, 2010 | |
| Charles Thompson | 5% Or Greater Direct Ownership Interest | Aug 18, 2010 |
Practitioners & affiliated clinicians
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.
-
- Pharmacist
- Orangeburg, SC
- NPI 1841512365
Affiliated clinicians 4
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284681600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1659052800000",
"number": "1467760058",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 701",
"city": "ORANGEBURG",
"state": "SC",
"postal_code": "291160701",
"telephone_number": "803-536-0007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1324 CHESTNUT STREET",
"city": "ORANGEBURG",
"state": "SC",
"postal_code": "29115",
"telephone_number": "803-536-0007"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GROVE PARK PHARMACY HOSPICE CARE",
"organizational_subpart": "NO",
"enumeration_date": "2010-09-17",
"last_updated": "2022-07-29",
"certification_date": "2022-07-29",
"status": "A",
"authorized_official_last_name": "THOMPSON",
"authorized_official_first_name": "CHARLES",
"authorized_official_middle_name": "P",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "803-536-0007",
"authorized_official_name_prefix": "Mr.",
"authorized_official_name_suffix": "Jr."
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": "SC",
"license": "HPC0155",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "HSP118",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HOSPICE LICENSE",
"identifier": "HPC0155",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Orangeburg, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2022; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.