NPIMap

Organization Active NPI

McLeod Medical Center-Dillon

Doing business as McLeod Dillon Emergency

  • Hospitalist Physician
  • Dillon, SC
National Provider Identifier
1720033988
Registry record updated May 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
MCLEOD MEDICAL CENTER-DILLON
Doing business as
McLeod Dillon Emergency
Practice address
301 E Jackson St
Dillon, SC 29536-2509
Phone
(843) 774-4111
Fax
(843) 777-5035
NPI assigned
May 24, 2006
Last updated
May 28, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
MCLEOD HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 28, 2026

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X NU
Anesthesiology Physician 207L00000X NU
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X NU
Hospitalist Physician 208M00000X NU Primary

Addresses

Primary practice location

301 E Jackson St
Dillon, SC 29536-2509

Mailing address

PO Box 601743
Charlotte, NC 28260-1743

Other identifiers 1

IdentifierTypeStateIssuer
GP1977MedicaidSC

Other names 1

  • MCLEOD DILLON EMERGENCY Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031203000480 SC Part B Supplier - Clinic/Group Practice 3476465311 Receives reassigned benefits from 122 practitioners
Practice locations: Dillon, SC

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

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

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 124

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 124

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779926400000",
    "number": "1720033988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601743",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601743"
        },
        {
            "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": "843-774-4111",
            "fax_number": "843-777-5035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLEOD MEDICAL CENTER-DILLON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCLEOD HEALTH",
        "enumeration_date": "2006-05-24",
        "last_updated": "2026-05-28",
        "certification_date": "2026-05-28",
        "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": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP1977",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MCLEOD DILLON EMERGENCY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MCLEOD DILLON EMERGENCY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dillon, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.