NPIMap

Organization Active NPI

Eau Claire Cooperative Health Center, Inc.

Doing business as Five Points Walk-In Center

  • Federally Qualified Health Center (FQHC)
  • Columbia, SC
National Provider Identifier
1467763391
Registry record updated Jan 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Doing business as
Five Points Walk-In Center
Practice address
1228 Harden St Ste a
Columbia, SC 29204-1800
Phone
(803) 748-7002
Fax
(803) 252-5259
NPI assigned
Jun 25, 2010
Last updated
Jan 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2023

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

Authorized official

Name
Delgado Cantave
Title
Ceo
Phone
(803) 733-5969

Specialties & licenses 1

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

Addresses

Primary practice location

1228 Harden St Ste a
Columbia, SC 29204-1800

Mailing address

PO Box 3788
Columbia, SC 29230-3788
Phone (803) 753-5991

Other identifiers 2

IdentifierTypeStateIssuer
FQC031MedicaidSC
4350OtherSCMEDICARE PART B

Other names 1

  • Five Points Walk-In Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130329000159 SC Part A Provider - Federally Qualified Health Center (FQHC) 3274434220 Practice locations: Columbia, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467763391. Details of each certification follow.

Federally qualified health center certification: CCN 421986

Legal name
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Doing business as
FIVE POINTS WALK-IN CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 29, 2013
Last certification
Mar 29, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 14, 1992 in SC
Enrollment address
1228 Harden St
Ste a
Columbia, SC 29204-1800

National Provider Directory

National Provider Directory
Tax ID family
Winnsboro Pediatrics Famil44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Karla Gilliam Individual 5% Or Greater Direct Ownership Interest Jan 1, 2019 5%
Hasan Ross-El Individual 5% Or Greater Direct Ownership Interest Jan 1, 2019 5%
Thomas Mayer Individual 5% Or Greater Direct Ownership Interest Jan 1, 2019 5%
Dana Schultz Individual Corporate OfficerCfo Mar 27, 2026
W-2 Managing EmployeeCfo Mar 27, 2026
Diane Torrales Individual 5% Or Greater Direct Ownership Interest Jan 1, 2019 5%
Dean Slade Individual 5% Or Greater Direct Ownership Interest Jan 1, 2019 5%
Julie Smithwick Individual 5% Or Greater Direct Ownership Interest Jan 1, 2019 5%
Shanice Bligen Individual 5% Or Greater Direct Ownership Interest Jan 1, 2019 5%
Generett Dingle Individual 5% Or Greater Direct Ownership Interest Jan 1, 2019 5%
Elaine Eskew Individual 5% Or Greater Direct Ownership Interest Jan 1, 2019 5%

All facility ownership & control disclosures 14

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Eau Claire Cooperative Health Center, Inc.Columbia, SC, CCN 421843 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2019
Eastover Family PracticeEastover, SC, CCN 421960 Federally qualified health center Operational/Managerial Control Jan 26, 2012
Pediatrics of NewberryNewberry, SC, CCN 421970 Federally qualified health center 5% Or Greater Direct Ownership Interest Jul 1, 2014
Waverly Women's Health & Internal MedicineBatesburg Leesville, SC, CCN 421974 Federally qualified health center 5% Or Greater Direct Ownership Interest Jun 1, 2010
Eau Claire PodiatryColumbia, SC, CCN 421968 Federally qualified health center 5% Or Greater Direct Ownership Interest Mar 7, 2022
Sterling Sharpe PediatricsSuite 1, SC, CCN 421972 Federally qualified health center 5% Or Greater Direct Ownership Interest Nov 4, 2014
Pelion Pediatrics Family & DentalPelion, SC, CCN 421977 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 19, 2012
Brookland Community PediatricsWest Columbia, SC, CCN 421978 Federally qualified health center 5% Or Greater Direct Ownership Interest Jul 1, 2010
Pediatrics of Batesburg-LeesburgBatesburg-Leesville, SC, CCN 421980 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 30, 2012
Eau Claire Walk-inColumbia, SC, CCN 421023 Federally qualified health center 5% Or Greater Direct Ownership Interest Mar 7, 2022
Five Points Behavioral Health at Hand Middle SchoolColumbia, SC, CCN 421064 Federally qualified health center Operational/Managerial Control Jan 1, 2016
Eau Claire Cooperative Health Center, Inc.Little Mountain, SC, CCN 421068 Federally qualified health center Operational/Managerial Control Jan 1, 2016
Columbia Community Family PracticeColumbia, SC, CCN 871035 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2016
Advantage Eye CareColumbia, SC, CCN 871038 Federally qualified health center 5% Or Greater Direct Ownership Interest Jun 1, 2022

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1277424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673395200000",
    "number": "1467763391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3788",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292303788",
            "telephone_number": "803-753-5991",
            "fax_number": "803-753-5591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1228 HARDEN ST STE A",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292041800",
            "telephone_number": "803-748-7002",
            "fax_number": "803-252-5259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-25",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A",
        "authorized_official_last_name": "CANTAVE",
        "authorized_official_first_name": "DELGADO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-733-5969"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC031",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "4350",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Five Points Walk-In Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.