NPIMap

Organization Active NPI

Hampton Regional Medical Center

Doing business as Coastal Plains Primary Care

  • Rural Health Clinic/Center
  • Varnville, SC
National Provider Identifier
1780744946
Registry record updated Jun 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HAMPTON REGIONAL MEDICAL CENTER
Doing business as
Coastal Plains Primary Care
Practice address
595 W Carolina Ave
Varnville, SC 29944-4735
Phone
(803) 943-7600
Fax
(803) 943-7601
NPI assigned
Dec 11, 2006
Last updated
Jun 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2024

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

Authorized official

Name
Julie B Allen
Title
Cfo
Phone
(803) 943-1254

Specialties & licenses 1

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

Addresses

Primary practice location

595 W Carolina Ave
Varnville, SC 29944-4735

Mailing address

595 W Carolina Ave
Varnville, SC 29944-4735
Phone (803) 943-7600

Other identifiers 1

IdentifierTypeStateIssuer
RHC155MedicaidSC

Other names 1

  • Coastal Plains Primary Care Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address CoastalPlains@coastalplains.direct.sceha.org Direct

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031216000246 SC Part B Supplier - Clinic/Group Practice 0941107296 Receives reassigned benefits from 47 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Varnville, SC
O20051123000171 SC Part A Provider - Rural Health Clinic 0941107296 Practice locations: Varnville, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780744946. Details of each certification follow.

Rural health clinic certification: CCN 423432

Legal name
HAMPTON REGIONAL MEDICAL CENTER
Doing business as
MALCOLM W. HORRY, MD
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 21, 2005
Last certification
Mar 13, 2023
Ownership / control type
2A
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1995 in SC
Enrollment address
595 W Carolina Ave
Varnville, SC 29944-4735
Related CCNs
420072

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

Locations

595 W Carolina Ave
#A
Varnville, SC 29944
Phone 80394327711217

Interoperability endpoints

  • Direct secure messaging: coastalplains@coastalplains.direct.sceha.org

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Dave Hamill Individual Corporate OfficerCeo Nov 23, 2005 100%
Operational/Managerial ControlCeo Nov 23, 2005 100%

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Hampton Regional Medical CenterVarnville, SC, CCN 420072 Hospital Operational/Managerial Control Jan 1, 1990
Hampton Regional Medical CenterVarnville, SC, CCN 42U072 Hospital Operational/Managerial Control Apr 7, 2011

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 45

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 45

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717372800000",
    "number": "1780744946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 W CAROLINA AVE",
            "city": "VARNVILLE",
            "state": "SC",
            "postal_code": "299444735",
            "telephone_number": "803-943-7600",
            "fax_number": "803-943-7601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 W CAROLINA AVE",
            "city": "VARNVILLE",
            "state": "SC",
            "postal_code": "299444735",
            "telephone_number": "803-943-7600",
            "fax_number": "803-943-7601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAMPTON REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "803-943-1254"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC155",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "CoastalPlains@coastalplains.direct.sceha.org",
            "affiliation": "N",
            "endpointDescription": "Direct",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "595 W Carolina Ave",
            "city": "Varnville",
            "state": "SC",
            "country_code": "US",
            "postal_code": "299444735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Coastal Plains Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coastal Plains Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Varnville, SC

Sources for this page

Verify at the official NPI Registry.