Edisto Regional Health Services Inc.
Organization Active NPI Rural Health Clinic/Center · Orangeburg, SC
NPI 1639475429 · NPPES record last updated Feb 26, 2020
Key facts
- NPI
- 1639475429
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- EDISTO REGIONAL HEALTH SERVICES INC.
- Practice address
- 1619 Carolina Ave
Orangeburg, SC 29115-4939 - Phone
- (803) 531-7474
- Fax
- (803) 531-7457
- NPI assigned
- Jan 27, 2011
- Organization subpart
- Yes
- Parent organization (as reported)
- EDISTO REGIONAL HEALTH SERVICES INC.
Authorized official
- Name
- Liza M Porterfield
- Title
- C F O
- Phone
- (803) 395-4458
Other NPIs on the same Medicare enrollment 17
Member of 1
Change of ownership 1
Practitioners 3
-
William Leroy Baly, M.D.
-
William N Braswell, M.D.
-
Erin Suzanne Castellano, A.P.R.N
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Mar 1, 2023 | Change of Ownership |
Musc Helath Primary Care - Carolina Avenue |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040810000307 | SC | Part B Supplier - Clinic/Group Practice | 4981693447 |
Receives reassigned benefits from 41 practitioners 17 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bowman, SC; Bamberg, SC; Santee, SC; Saint Matthews, SC; Orangeburg, SC; Holly Hill, SC; Branchville, SC |
National Provider Directory
- Part of
- Low Country Pain Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | SC | Yes |
Addresses
Primary practice location
1619 Carolina Ave
Orangeburg, SC 29115-4939
Mailing address
PO Box 1245
Orangeburg, SC 29116-1245
Phone (803) 395-4762
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 018 | Other | SC | BCBS |
| 018 | Other | SC | BLUECHOICE |
| 016 | Other | SC | TRICARE |
| GP5343 | Medicaid | SC | |
| CK8831 | Other | SC | RRMEDICARE |
| RHC217 | Medicaid | SC | |
| CN8991 | Other | SC | RRMEDICARE |
Other names
- RMC Primary Care Carolina Ave
- RMC Primary Care Edisto Practice
Other providers in Orangeburg, SC
- Edisto Regional Health Services Inc
- Edisto Regional Health Services Inc.
- Edisto Regional Health Services Inc.
- Edisto Regional Health Services Inc.
- Edisto Regional Health Services Inc.
- Edisto Regional Health Services Inc.
- Edisto Regional Health Services, Inc
- Edisto Regional Medical Center
- Edisto Urological Associates
- Kara Charnelle Edmond
All providers in Orangeburg, SC · Rural Health Clinic/Center in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.