NPIMap

Organization Active NPI

Abbeville County Memorial Hospital

Doing business as Due West Family Medicine

  • Rural Health Clinic/Center
  • Due West, SC
National Provider Identifier
1467825166
Registry record updated Nov 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ABBEVILLE COUNTY MEMORIAL HOSPITAL
Doing business as
Due West Family Medicine
Practice address
6 College St
Due West, SC 29639-9554
Phone
(864) 379-2345
Fax
(864) 379-3228
NPI assigned
Nov 4, 2015
Reactivated
Aug 25, 2020
Last updated
Nov 5, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ABBEVILLE COUNTY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 5, 2024

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

Authorized official

Name
Matthew Tolbert Logan
Title
President/Ceo
Phone
(864) 725-4780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

6 College St
Due West, SC 29639-9554

Mailing address

PO Box 887
Abbeville, SC 29620-0887
Phone (864) 366-3279

Other identifiers 1

IdentifierTypeStateIssuer
RHC240MedicaidSC

Other names 1

  • Due West Family Medicine Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031117000214 SC Part B Supplier - Clinic/Group Practice 7719891506 Receives reassigned benefits from 102 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Abbeville, SC; Due West, SC
O20151216002979 SC Part A Provider - Rural Health Clinic 7719891506 Practice locations: Due West, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467825166. Details of each certification follow.

Rural health clinic certification: CCN 423453

Legal name
ABBEVILLE COUNTY MEMORIAL HOSPITAL
Doing business as
DUE WEST FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 2, 2016
Last certification
Nov 20, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
May 20, 2010 in SC
Enrollment address
6 College St
Due West, SC 29639-9554
Related CCNs
421301

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
J E Todd M Gonzalez MD2 organizations share this tax ID, including this one
Part of
J E Todd M Gonzalez MD

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Matthew T Logan Individual Corporate OfficerPresident/Ceo Oct 1, 2023
Self Regional Healthcare Organization, Greenwood, SC Non-profit Operational/Managerial Control Oct 1, 2023 100%
William F Gordon Individual Corporate OfficerCao Oct 1, 2024
W-2 Managing Employee Oct 1, 2024
Clint J Stewart Individual Corporate OfficerVP & Cfo Oct 1, 2024
W-2 Managing Employee Oct 21, 2024
Abbeville County Memorial Hospital Organization, Abbeville, SC Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2016 100%

Owners & managing parties with NPI records 20

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

View all 20

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Abbeville Area Healthcare CenterAbbeville, SC, CCN 423451 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2010

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 9

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1446595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730764800000",
    "number": "1467825166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 887",
            "city": "ABBEVILLE",
            "state": "SC",
            "postal_code": "296200887",
            "telephone_number": "864-366-3279",
            "fax_number": "864-366-3317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 COLLEGE ST",
            "city": "DUE WEST",
            "state": "SC",
            "postal_code": "296399554",
            "telephone_number": "864-379-2345",
            "fax_number": "864-379-3228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABBEVILLE COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ABBEVILLE COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2015-11-04",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "deactivation_date": "2020-06-02",
        "reactivation_date": "2020-08-25",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "TOLBERT",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "864-725-4780"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC240",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Due West Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Due West Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Due West, SC

Sources for this page

Verify at the official NPI Registry.