Edisto Home Care & Hospice, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

EDISTO HOME CARE & HOSPICE, LLC

Practice address

1180 Boulevard St
Suite C
Orangeburg, SC 29115-4312

Phone

(803) 707-3795

Fax

(803) 997-2880

NPI assigned

Apr 21, 2017

Last updated

Apr 21, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kevin Jackson

Title

Vice President

Phone

(803) 707-3795

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578098190. Details of each certification follow.

• CCN 421634 Hospice · Active · Details

Hospice certification: CCN 421634

Legal name

EDISTO HOME CARE & HOSPICE LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Nov 1, 2017

Last certification

Dec 7, 2020

Ownership / control type

Proprietary - Partnership

Organization structure

LLCProprietary

Incorporated

Mar 24, 2017 in SC

Enrollment address

1180 Boulevard St
Ste a
Orangeburg, SC 29115-4324

Listed as

Edisto Home Care & HospiceCCN 421634 · All quality measures

Ownership

For-Profit

Certified

Nov 1, 2017

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 7

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

Owners & managing parties with NPI records 1

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

• John H Hayden Jr., MD

  • Family Medicine Physician
  • Orangeburg, SC
  • NPI 1598721243

  Contracted Managing Employee

  CMS ownership

Practitioners 1

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.

• Sherri Cassidy, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Ehrhardt, SC
  • NPI 1750057253
  NPD (past)

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Michael L Blubaugh, MD

  • Internal Medicine Physician
  • Walterboro, SC
  • NPI 1013016138

  Hospice

  Care Compare affiliation
• Richard Lee Carpenter Jr., MD

  • Family Medicine Physician
  • Elloree, SC
  • NPI 1376600486

  Hospice

  Care Compare affiliation
• John H Hayden Jr., MD

  • Family Medicine Physician
  • Orangeburg, SC
  • NPI 1598721243

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1492732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492732800000",
    "number": "1578098190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 BOULEVARD ST",
            "address_2": "SUITE C",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291154312",
            "telephone_number": "803-707-3795",
            "fax_number": "803-997-2880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 BOULEVARD ST",
            "address_2": "SUITE C",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291154312",
            "telephone_number": "803-707-3795",
            "fax_number": "803-997-2880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDISTO HOME CARE & HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-21",
        "last_updated": "2017-04-21",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "803-707-3795"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon W Easterlin, NP
• Ashley Marie Easterling, RN,MSN,APRN,PMHNP-BC
• Sharon Inabinet Eden, M.D.
• James Patrick Edens II, CRNA
• Edisto Dental Associates LLC
• Edisto OBGYN PA
• Edisto Regional Health Services (Copeland Medical Care)
• Edisto Regional Health Services (James H. Brunson, Jr, MD)
• Edisto Regional Health Services (Edisto Regional Pediatrics)
• Edisto Regional Health Services Inc (RMC Express Care)

• Community Based Hospice Care Agency in Orangeburg, SC
• Providers in Orangeburg, SC by specialty
• Community Based Hospice Care Agency in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.