NPIMap

Organization Active NPI

Cherokee Pediatric Associates, LLC

Doing business as Carolina Pediatric Associates

  • Rural Health Clinic/Center
  • Blacksburg, SC
National Provider Identifier
1730233172
Registry record updated Feb 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
23503 Issued in SC
Legal business name
CHEROKEE PEDIATRIC ASSOCIATES, LLC
Doing business as
Carolina Pediatric Associates
Practice address
301 W Pine St
Blacksburg, SC 29702-1549
Phone
(864) 839-4325
Fax
(864) 839-9901
NPI assigned
Jan 23, 2007
Last updated
Feb 25, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2009

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

Authorized official

Name
Daren Edward Carling, MDNPI 1164495594
Title
Owner
Phone
(864) 839-4325

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 23503 SC Primary

Addresses

Primary practice location

301 W Pine St
Blacksburg, SC 29702-1549

Mailing address

301 W Pine St
Blacksburg, SC 29702-1549
Phone (864) 839-4325

Other identifiers 1

IdentifierTypeStateIssuer
RHC159MedicaidSC

Other names 1

  • Carolina Pediatric Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050819000744 SC Part A Provider - Rural Health Clinic 2062442940 Practice locations: Blacksburg, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730233172. Details of each certification follow.

Rural health clinic certification: CCN 428980

Legal name
CHEROKEE PEDIATRIC ASSOCIATES, LLC
Doing business as
CAROLINA PEDIATRIC ASSOCIATES
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 5, 2006
Last certification
Nov 7, 2022
Ownership / control type
1A
Organization structure
LLCProprietary
Incorporated
May 12, 2003 in SC
Enrollment address
301 W Pine St
Blacksburg, SC 29702-1549

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Carolina Pediatric Associates4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

1610B N Limestone St
Gaffney, SC 29340
Phone (864) 487-7337

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Daren Carling Individual 5% Or Greater Direct Ownership Interest Nov 1, 2003 100%
W-2 Managing EmployeePractice Admin Nov 1, 2003 25%
Amy Carling Individual W-2 Managing EmployeePractice Administrator Aug 19, 2005 50%

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235520000000",
    "number": "1730233172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 W PINE ST",
            "city": "BLACKSBURG",
            "state": "SC",
            "postal_code": "297021549",
            "telephone_number": "864-839-4325",
            "fax_number": "864-839-9901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W PINE ST",
            "city": "BLACKSBURG",
            "state": "SC",
            "postal_code": "297021549",
            "telephone_number": "864-839-4325",
            "fax_number": "864-839-9901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHEROKEE PEDIATRIC ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2009-02-25",
        "status": "A",
        "authorized_official_last_name": "CARLING",
        "authorized_official_first_name": "DAREN",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-839-4325",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "SC",
            "license": "23503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC159",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolina Pediatric Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blacksburg, SC

Sources for this page

Verify at the official NPI Registry.