NPIMap

Organization Active NPI

Allendale County Hospital Board

Doing business as Carolina Medical Associates

  • Family Medicine Physician
  • Fairfax, SC
National Provider Identifier
1730280561
Registry record updated May 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
HTL-041 Issued in SC
Legal business name
ALLENDALE COUNTY HOSPITAL BOARD
Doing business as
Carolina Medical Associates
Practice address
1787 Allendale Fairfax Hwy
Fairfax, SC 29827-9133
Phone
(803) 632-3311
Fax
(803) 632-3415
NPI assigned
Sep 26, 2006
Last updated
May 14, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
ALLENDALE COUNTY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 14, 2013

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

Authorized official

Name
Mr. Ken Hiatt
Title
Administrator
Phone
(803) 632-3311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X HTL-041 SC Primary

Addresses

Primary practice location

1787 Allendale Fairfax Hwy
Fairfax, SC 29827-9133

Mailing address

PO Box 218
Fairfax, SC 29827-0218
Phone (803) 632-3311

Other names 1

  • Carolina Medical Associates Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040304000896 SC Part B Supplier - Clinic/Group Practice 2567371610 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Allendale, SC; Fairfax, SC

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Carolina Medical Associ7 organizations share this tax ID, including this one
Part of
Carolina Medical Associ

Other organizations with this tax ID 6

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

Ownership & related parties

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Allendale County HospitalFairfax, SC, CCN 421300 Hospital Operational/Managerial Control (100%) Jan 1, 1996
Allendale County HospitalFairfax, SC, CCN 42Z300 Hospital Operational/Managerial Control (100%) Jan 1, 1996
John Edward Harter Nursing CenterFairfax, SC, CCN 425103 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 1, 1997
Nov 1, 1967
Allendale County Hospital BoardFairfax, SC, CCN 423428 Rural health clinic Operational/Managerial Control (100%) Apr 1, 2000

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 3

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": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368489600000",
    "number": "1730280561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 218",
            "city": "FAIRFAX",
            "state": "SC",
            "postal_code": "298270218",
            "telephone_number": "803-632-3311",
            "fax_number": "803-632-3415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1787 ALLENDALE FAIRFAX HWY",
            "city": "FAIRFAX",
            "state": "SC",
            "postal_code": "298279133",
            "telephone_number": "803-632-3311",
            "fax_number": "803-632-3415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLENDALE COUNTY HOSPITAL BOARD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALLENDALE COUNTY HOSPITAL",
        "enumeration_date": "2006-09-26",
        "last_updated": "2013-05-14",
        "status": "A",
        "authorized_official_last_name": "HIATT",
        "authorized_official_first_name": "KEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "803-632-3311",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "HTL-041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolina Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfax, SC

Sources for this page

Verify at the official NPI Registry.