NPIMap

Organization Active NPI

Carolina Health Centers, Inc.

Doing business as Village Family Practice

  • Federally Qualified Health Center (FQHC)
  • Greenwood, SC
National Provider Identifier
1518338698
Registry record updated Oct 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CAROLINA HEALTH CENTERS, INC.
Doing business as
Village Family Practice
Practice address
420 Epting Ave # B
Greenwood, SC 29646-4040
Phone
(864) 941-8121
Fax
(864) 330-8237
NPI assigned
Oct 14, 2015
Last updated
Oct 14, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2015

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

Authorized official

Name
Lisa Y Gilmer
Title
Revenue Cycle Manager
Phone
(864) 941-8121

Specialties & licenses 1

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

Addresses

Primary practice location

420 Epting Ave # B
Greenwood, SC 29646-4040

Mailing address

313 Main St Ste B
Greenwood, SC 29646-2757
Phone (864) 388-0301

Other names 1

  • Village Family Practice Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050825000437 SC Part B Supplier - Clinic/Group Practice 5496707804 Receives reassigned benefits from 37 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ridge Spring, SC; Waterloo, SC; Ware Shoals, SC; Saluda, SC; MC Cormick, SC; Greenwood, SC; Clinton, SC; Calhoun Falls, SC
O20151204000293 SC Part A Provider - Federally Qualified Health Center (FQHC) 5496707804 Practice locations: Greenwood, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1518338698. Details of each certification follow.

Federally qualified health center certification: CCN 421042

Legal name
CAROLINA HEALTH CENTERS INC
Doing business as
VILLAGE FAMILY PRACTICE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 18, 2016
Last certification
Jul 18, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 27, 1977 in SC
Enrollment address
420 Epting Ave B
Greenwood, SC 29646-4040

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Other NPIs on the same Medicare enrollment 10

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2101356Village Family Practice420 Epting Ave, Suite B, Greenwood, SC 29646Provider-performed microscopyJun 1, 2027

National Provider Directory

National Provider Directory
Tax ID family
Carolina Health Centers Inc12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

12541 Foster St
Ste 330
Overland Park, KS 66213
Phone (913) 345-2322

8900 W 135th St
Overland Park, KS 66221
Phone (913) 323-8865

4801 S Cliff Ave
Ste 300
Independence, MO 64055
Phone (816) 251-5200

5151 Troost Ave
Ste 200
Kansas City, MO 64110
Phone (816) 237-1616

20 NE Saint Lukes Blvd
Ste 350
Lees Summit, MO 64086
Phone (816) 347-5600

2737 NE McBaine Dr
Lees Summit, MO 64064
Phone (816) 251-5780

301 NE Mulberry St
Ste 202
Lees Summit, MO 64086
Phone (816) 251-5710

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Christopher Scott Clem Individual Corporate OfficerCfo Jun 16, 2025
W-2 Managing EmployeeCfo Jun 16, 2025
Mary Stackhouse Individual Corporate DirectorBoard Member Mar 26, 1998
Abby Banks Individual Corporate DirectorBoard Member Mar 27, 2017
Kimberly Kapetanakos Individual Corporate DirectorBoard Member Mar 17, 2017
Miriam Ferguson Individual Corporate OfficerCeo Jul 14, 2025 100%
Mario Luna Individual Corporate DirectorBoard Member Sep 29, 2014
Gail D Ferguson Individual Corporate DirectorBoard Member Jul 1, 1994
John Britt Individual Corporate OfficerChairman of Board Mar 25, 1985
Corporate DirectorBoard Member Mar 25, 1985
Gregory Bullard Individual Corporate OfficerVice Chairman, Finance Committee Jun 24, 1982
Corporate DirectorBoard Member Jun 24, 1985
Deborah Natvig Individual Corporate DirectorBoard Member Feb 22, 2010
Paul Grogan Individual Corporate OfficerChief Financial Officer Aug 6, 2012
Locke Eugene Simons Individual Corporate OfficerChief Medical Officer Apr 12, 2012

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 12

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": "1444780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444780800000",
    "number": "1518338698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 MAIN ST STE B",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296462757",
            "telephone_number": "864-388-0301",
            "fax_number": "864-388-0648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 EPTING AVE # B",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296464040",
            "telephone_number": "864-941-8121",
            "fax_number": "864-330-8237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA HEALTH CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-14",
        "last_updated": "2015-10-14",
        "status": "A",
        "authorized_official_last_name": "GILMER",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "864-941-8121"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Village Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenwood, SC

Sources for this page

Verify at the official NPI Registry.