NPIMap

Organization Active NPI

McLeod Medical Center-Dillon

  • General Acute Care Hospital
  • Dillon, SC
National Provider Identifier
1598746141
Registry record updated Mar 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
HTL-854 Issued in SC
Legal business name
MCLEOD MEDICAL CENTER-DILLON
Practice address
301 E Jackson St
Dillon, SC 29536-2509
Phone
(843) 777-4402
Fax
(843) 777-5249
NPI assigned
Nov 10, 2005
Last updated
Mar 2, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
MCLEOD HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 2, 2020

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

Authorized official

Name
Samuel Fulton Ervin III
Title
Sr VP and Cfo
Phone
(843) 777-2910

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X HTL-854 SC Primary

Addresses

Primary practice location

301 E Jackson St
Dillon, SC 29536-2509

Mailing address

PO Box 100567
Florence, SC 29501-0567
Phone (843) 777-4402

Other identifiers 3

IdentifierTypeStateIssuer
A00091MedicaidSC
4200005MedicaidNC
B00091MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031014000006 SC Part A Provider - Hospital 3476465311 Practice locations: Dillon, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598746141. Details of each certification follow.

Hospital certification: CCN 420005

Legal name
MCLEOD MEDICAL CENTER-DILLON
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 27, 2022
Beds
92
Ownership / control type
Private (not for profit)
Most recent change of ownership
Oct 1, 2003 (3 total)
Organization structure
CorporationProprietary
Incorporated
Jul 3, 2003 in SC
Enrollment address
301 East Jackson Street
Dillon, SC 29536-2509
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
McLeod Medical Center - DillonCCN 420005 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
McLeod Medical Center-Dillon3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 28

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

NameRoleSinceShare
Willie E Boyd Individual Corporate OfficerBoard of Trustees Feb 1, 2012
Frances S Jones Individual Corporate OfficerBoard of Trustees Jan 1, 2018
Ashley Brady Individual Corporate OfficerBoard of Trustees Jan 1, 2018
William N Boulware Individual Corporate OfficerBoard of Trustees Jan 1, 2018
Allie E Brooks Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Benjamin T Zeigler Individual Corporate OfficerBoard of Trustees Dec 1, 2009
Ronald M Fowler Individual Corporate OfficerBoard of Trustees Jan 1, 2012
Dudley B. Harrington Individual Corporate OfficerVP of Business Operations Jan 1, 2018
Virginia L Clyburn-Ipock Individual Corporate OfficerBoard of Trustees Jun 1, 2021
Jeannette Glenn Individual Corporate OfficerBoard of Trustees Jan 1, 2018
McLeod Health Organization, Florence, SC Non-profit 5% Or Greater Direct Ownership Interest Jul 3, 2003
Samuel F Ervin Individual Corporate DirectorSenior Vice President and Cfo Oct 15, 2007
Raymond Clark Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Hugh S Blair Individual Corporate OfficerBoard of Trustees Jan 1, 2018
Mary Anderson Individual Corporate OfficerBoard of Trustees Jan 1, 2018
Tracy Ray Individual Corporate OfficerBoard of Trustees Jan 1, 2012
Donna Isgett Individual Corporate OfficerPresident and Ceo Mar 1, 2021
Tarek M Bishara Individual Corporate OfficerBoard of Trustees Jan 1, 2018
Beverly Hazelwood Individual Corporate OfficerBoard of Trustees Jan 1, 2018
Amy Fisher Individual Corporate Officer Jun 1, 2021
Amit Vyankatesh Pande Individual Corporate OfficerBoard of Trustees Jun 1, 2021
Frank V Boulineau Individual Corporate OfficerBoard of Trustees Jan 1, 2012
Joan Ervin Individual W-2 Managing EmployeeVice President and Administrator Jan 1, 2016
Patrick Kerry Denton Individual Corporate OfficerBoard of Trustees Jan 1, 2018
Frank J Brand Individual Corporate OfficerBoard of Trustees Jan 1, 2018
James C Smith Individual Corporate OfficerBoard of Trustees Jan 1, 2021
Carl J Chelen Individual Corporate OfficerChief of Staff Jan 1, 2022
John R Braddy Individual Corporate OfficerBoard of Trustees Jan 1, 2007

Owners & managing parties with NPI records 7

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

Facilities with the same owner 17

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 17

Practitioners & affiliated clinicians

Practitioners 7

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.

Affiliated clinicians 206

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

View all 206

NPI Registry JSON

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583107200000",
    "number": "1598746141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100567",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295010567",
            "telephone_number": "843-777-4402",
            "fax_number": "843-777-5249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E JACKSON ST",
            "city": "DILLON",
            "state": "SC",
            "postal_code": "295362509",
            "telephone_number": "843-777-4402",
            "fax_number": "843-777-5249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLEOD MEDICAL CENTER-DILLON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCLEOD HEALTH",
        "enumeration_date": "2005-11-10",
        "last_updated": "2020-03-02",
        "certification_date": "2020-03-02",
        "status": "A",
        "authorized_official_last_name": "ERVIN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "FULTON",
        "authorized_official_title_or_position": "SR VP AND CFO",
        "authorized_official_telephone_number": "843-777-2910",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "SC",
            "license": "HTL-854",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A00091",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4200005",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "B00091",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dillon, SC

Sources for this page

Verify at the official NPI Registry.