NPIMap

Organization Active NPI

Caresouth Carolina, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hartsville, SC
National Provider Identifier
1720082571
Registry record updated Sep 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CARESOUTH CAROLINA, INC.
Practice address
1268 S 4TH St
Hartsville, SC 29550-0703
Phone
(843) 332-3422
NPI assigned
Jun 9, 2005
Last updated
Sep 4, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2007

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

Authorized official

Name
Ann Lewis
Title
Ceo
Phone
(843) 857-0111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1268 S 4TH St
Hartsville, SC 29550-0703

Mailing address

201 S 5TH St
Hartsville, SC 29550-4211

Other identifiers 2

IdentifierTypeStateIssuer
FQC015MedicaidSC
CBP011MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040511000280 SC Part B Supplier - Clinic/Group Practice 1052221314 Receives reassigned benefits from 95 practitioners
17 other NPIs on this enrollment
Practice locations: Society Hill, SC; MC Coll, SC; Latta, SC; Lake View, SC; Hartsville, SC; Dillon, SC; Chesterfield, SC; Cheraw, SC…
O20100526000251 SC Part A Provider - Federally Qualified Health Center (FQHC) 1052221314 Practice locations: Hartsville, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720082571. Details of each certification follow.

Federally qualified health center certification: CCN 421846

Legal name
CARESOUTH CAROLINA INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 6, 1994
Last certification
Jan 6, 1994
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Apr 5, 1978 in SC
Enrollment address
1268 S 4TH St
Hartsville, SC 29550-0703

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Caresouth Carolina Inc26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

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

View all 25

Locations

210 W Main St
Bennettsville, SC 29512
Phone (843) 332-5121

201 S 5th St
Hartsville, SC 29550

122 Latimer St
Latta, SC 29565
Phone (843) 627-6252

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Mary J Garvin Individual Corporate OfficerBoard Member Apr 7, 1978
Ennis R Bryant Individual Corporate OfficerBoard Member-Vice Chairperson Jan 1, 1992
Flossie W Bartell Individual Corporate OfficerBoard Member-Treasurer Jun 26, 2003
Teresa Gainey Individual Corporate OfficerBoard Member Dec 19, 2019
Ann Marie Lewis Individual Corporate OfficerCeo Apr 5, 1978
W-2 Managing EmployeeCeo Apr 5, 1978
Trudy Drawhorn Individual Corporate OfficerBoard Member Jul 27, 2017
Earnestine S Powe Individual Corporate OfficerBoard Member-Assistant Secretary Jan 1, 1984
Patricia M Henegan Individual Corporate OfficerBoard Member Jul 27, 2017
Dorothy S Joyner Individual Corporate OfficerBoard Member Jan 1, 1996
Gene T Harper Individual Corporate DirectorBoard Member Oct 16, 2023
Bonnie M Seals Individual Corporate OfficerBoard Member-Secretary Jan 1, 1996
Mary D Legrant Individual Corporate OfficerBoard Member Jan 1, 1996
Jay S Hodge Individual Corporate OfficerBoard Member-Chairperson Jan 1, 1998

Practitioners & affiliated clinicians

Practitioners 101

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 101

NPI Registry JSON

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188864000000",
    "number": "1720082571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 S 5TH ST",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295504211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1268 S 4TH ST",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295500703",
            "telephone_number": "843-332-3422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARESOUTH CAROLINA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-09",
        "last_updated": "2007-09-04",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-857-0111"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC015",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CBP011",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartsville, SC

Sources for this page

Verify at the official NPI Registry.