NPIMap

Organization Active NPI

McLeod Health Clarendon

  • Certified Registered Nurse Anesthetist
  • Manning, SC
National Provider Identifier
1508218793
Registry record updated Feb 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
MCLEOD HEALTH CLARENDON
Practice address
10 E Hospital St
Manning, SC 29102-3153
Phone
(843) 435-8463
NPI assigned
Jul 12, 2016
Last updated
Feb 25, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
MCLEOD HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 25, 2019

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

Authorized official

Name
Samuel F Ervin III
Title
Sr Vice President and Cfo
Phone
(843) 777-2910

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X Primary
Emergency Medicine Physician 207P00000X

Addresses

Primary practice location

10 E Hospital St
Manning, SC 29102-3153

Mailing address

10 E Hospital St
Manning, SC 29102-3153

Other identifiers 2

IdentifierTypeStateIssuer
G064OtherSCMEDICARE
GP7479MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160915000930 SC Part B Supplier - Clinic/Group Practice 0840582656 Receives reassigned benefits from 214 practitioners
6 other NPIs on this enrollment
Practice locations: Timmonsville, SC; Manning, SC; Kingstree, SC; Johnsonville, SC

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 230

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 230

NPI Registry JSON

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

{
    "created_epoch": "1468281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551052800000",
    "number": "1508218793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 E HOSPITAL ST",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291023153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 E HOSPITAL ST",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291023153",
            "telephone_number": "843-435-8463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLEOD HEALTH CLARENDON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCLEOD HEALTH",
        "enumeration_date": "2016-07-12",
        "last_updated": "2019-02-25",
        "status": "A",
        "authorized_official_last_name": "ERVIN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "SR VICE PRESIDENT AND CFO",
        "authorized_official_telephone_number": "843-777-2910",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "G064",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP7479",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manning, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; 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.