NPIMap

Organization Active NPI

Clemson University

  • Rural Health Clinic/Center
  • Walhalla, SC
National Provider Identifier
1568345445
Registry record updated Dec 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CLEMSON UNIVERSITY
Practice address
200 Booker Dr
Walhalla, SC 29691-2278
Phone
(864) 656-3076
NPI assigned
Jul 29, 2025
Last updated
Dec 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2025

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

Authorized official

Name
Ronald W Gimbel
Title
Director Clemson Rural Health
Phone
(864) 656-3076

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Nurse Practitioner 363LF0000X NU

Addresses

Primary practice location

200 Booker Dr
Walhalla, SC 29691-2278

Mailing address

101 Edwards Hall
Clemson, SC 29634-0001
Phone (864) 656-3076

Other names 1

  • Clemson University Clemson Rural Health Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211015002755 SC Part A Provider - Rural Health Clinic 1850393786 1 other NPI on this enrollment
Practice locations: Walhalla, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568345445. Details of each certification follow.

Rural health clinic certification: CCN 873807

Legal name
CLEMSON UNIVERSITY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 6, 2022
Last certification
Jul 6, 2022
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
200 Booker Dr
Walhalla, SC 29691-2278

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Clemson Univ Fire and EMS8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Clemson University Organization, Walhalla, SC 5% Or Greater Direct Ownership Interest Jul 1, 2019 100%
Ronald W. Gimbel Individual Corporate DirectorDirector, Clemson Rural Health Jul 1, 2019 100%
Michael J. Nebesky Individual OtherDirector, Procurement Jul 1, 2019
Caitlin Moore Individual Operational/Managerial ControlAssoc. Direct., Clinical Operations Jan 1, 2021 100%

Owners & managing parties with NPI records 3

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

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1753747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765756800000",
    "number": "1568345445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 EDWARDS HALL",
            "city": "CLEMSON",
            "state": "SC",
            "postal_code": "296340001",
            "telephone_number": "864-656-3076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BOOKER DR",
            "city": "WALHALLA",
            "state": "SC",
            "postal_code": "296912278",
            "telephone_number": "864-656-3076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEMSON UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-29",
        "last_updated": "2025-12-15",
        "certification_date": "2025-12-15",
        "status": "A",
        "authorized_official_last_name": "GIMBEL",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "DIRECTOR CLEMSON RURAL HEALTH",
        "authorized_official_telephone_number": "864-656-3076"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clemson University Clemson Rural Health",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Walhalla, SC

Sources for this page

Verify at the official NPI Registry.