NPIMap

Organization Active NPI

Fetter Health Care Network Inc

Doing business as Fetter Health Care Network-Johns Island Site

  • Federally Qualified Health Center (FQHC)
  • Johns Island, SC
National Provider Identifier
1487053021
Registry record updated Oct 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FETTER HEALTH CARE NETWORK INC
Doing business as
Fetter Health Care Network-Johns Island Site
Practice address
3627 Maybank Hwy
Johns Island, SC 29455-4825
Phone
(843) 628-0284
Fax
(843) 559-9912
NPI assigned
Aug 20, 2014
Last updated
Oct 18, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2016

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

Authorized official

Name
Aretha Jones
Title
Ceo
Phone
(843) 722-4112

Specialties & licenses 1

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

Addresses

Primary practice location

3627 Maybank Hwy
Johns Island, SC 29455-4825

Mailing address

51 Nassau St
Charleston, SC 29403-5513
Phone (843) 722-4112

Other identifiers 1

IdentifierTypeStateIssuer
FQC182MedicaidSC

Other names 1

  • Fetter Health Care Network-Johns Island Site Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070507000192 SC Part B Supplier - Clinic/Group Practice 9032215199 Receives reassigned benefits from 91 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Walterboro, SC; Cross, SC; Summerville, SC; North Charleston, SC; N Charleston, SC; Charleston, SC; Johns Island, SC; Hollywood, SC

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1408492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476748800000",
    "number": "1487053021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 NASSAU ST",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294035513",
            "telephone_number": "843-722-4112",
            "fax_number": "843-577-8960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3627 MAYBANK HWY",
            "city": "JOHNS ISLAND",
            "state": "SC",
            "postal_code": "294554825",
            "telephone_number": "843-628-0284",
            "fax_number": "843-559-9912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FETTER HEALTH CARE NETWORK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-20",
        "last_updated": "2016-10-18",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "ARETHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-722-4112"
    },
    "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": "FQC182",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fetter Health Care Network-Johns Island Site",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johns Island, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.