NPIMap

Organization Active NPI

Eau Claire Cooperative Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Pelion, SC
National Provider Identifier
1659657682
Registry record updated Feb 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC
Practice address
8063 Edmund Hwy
Pelion, SC 29123-9805
Phone
(803) 894-3736
Fax
(803) 894-5315
NPI assigned
Oct 21, 2011
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Delgado Cantave
Title
Ceo
Phone
(803) 733-5969

Facilities with the same owner 13

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

View all 13

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121019000326 SC Part a Provider - Federally Qualified Health Center (FQHC) 3274434220 Practice locations: Pelion, SC

Federally qualified health center certification: CCN 421977

Medicare enrollment files
Legal name
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Doing business as
PELION PEDIATRICS FAMILY & DENTAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 19, 2012
Last certification
Oct 19, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
in SC
Enrollment address
8063 Edmund Hwy
Pelion, SC 29123-9805

All disclosed owners & managing parties 3

Medicare enrollment files

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

NameRoleSinceShare
Eau Claire Cooperative Health Center, Inc. Organization, Pelion, SC Corporation 5% Or Greater Direct Ownership Interest Oct 19, 2012
Karena S White Individual Corporate Officer Dec 21, 2020
W-2 Managing Employee Dec 21, 2020
Junior Delgado Cantave Individual Contracted Managing Employee Sep 28, 2016
Corporate Director Sep 28, 2016
W-2 Managing Employee Sep 28, 2016

All facility ownership & control disclosures 13

Medicare enrollment files

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Eau Claire Cooperative Health Center, Inc.Columbia, SC, CCN 421843 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2019
Eastover Family PracticeEastover, SC, CCN 421960 Federally qualified health center Operational/Managerial Control Jan 26, 2012
Pediatrics of NewberryNewberry, SC, CCN 421970 Federally qualified health center 5% Or Greater Direct Ownership Interest Jul 1, 2014
Waverly Women'S Health & Internal MedicineBatesburg Leesville, SC, CCN 421974 Federally qualified health center 5% Or Greater Direct Ownership Interest Jun 1, 2010
Eau Claire PodiatryColumbia, SC, CCN 421968 Federally qualified health center 5% Or Greater Direct Ownership Interest Mar 7, 2022
Sterling Sharpe PediatricsSuite 1, SC, CCN 421972 Federally qualified health center 5% Or Greater Direct Ownership Interest Nov 4, 2014
Brookland Community PediatricsWest Columbia, SC, CCN 421978 Federally qualified health center 5% Or Greater Direct Ownership Interest Jul 1, 2010
Pediatrics of Batesburg-LeesburgBatesburg-Leesville, SC, CCN 421980 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 30, 2012
Eau Claire Walk-inColumbia, SC, CCN 421023 Federally qualified health center 5% Or Greater Direct Ownership Interest Mar 7, 2022
Five Points Behavioral Health at Hand Middle SchoolColumbia, SC, CCN 421064 Federally qualified health center Operational/Managerial Control Jan 1, 2016
Eau Claire Cooperative Health Center, Inc.Little Mountain, SC, CCN 421068 Federally qualified health center Operational/Managerial Control Jan 1, 2016
Columbia Community Family PracticeColumbia, SC, CCN 871035 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2016
Advantage Eye CareColumbia, SC, CCN 871038 Federally qualified health center 5% Or Greater Direct Ownership Interest Jun 1, 2022

National Provider Directory

National Provider Directory
Tax ID family
Eau Claire Cooperative Health Center Inc42 organizations share this tax ID, including this one

Other organizations with this tax ID 41

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

View all 41

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

8063 Edmund Hwy
Pelion, SC 29123-9805

Mailing address

PO Box 3788
Columbia, SC 29230-3788
Phone (803) 733-5969

Other identifiers 3

NPPES NPI Registry
IdentifierTypeStateIssuer
FQC031MedicaidSC
FQC118MedicaidSC
CBP018MedicaidSC

Other names 1

NPPES NPI Registry
  • Pelion Pediatrics, Family Practice, and Dentistry Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 3, 2022.

{
    "created_epoch": "1319155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643846400000",
    "number": "1659657682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3788",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292303788",
            "telephone_number": "803-733-5969",
            "fax_number": "803-753-5591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8063 EDMUND HWY",
            "city": "PELION",
            "state": "SC",
            "postal_code": "291239805",
            "telephone_number": "803-894-3736",
            "fax_number": "803-894-5315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAU CLAIRE COOPERATIVE HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-21",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A",
        "authorized_official_last_name": "CANTAVE",
        "authorized_official_first_name": "DELGADO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-733-5969"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC031",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC118",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CBP018",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pelion Pediatrics, Family Practice, and Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pelion, SC

Sources for this page

Verify at the official NPI Registry.