NPIMap

Organization Active NPI

Caresouth Carolina, Inc.

  • Federally Qualified Health Center (FQHC)
  • McColl, SC
National Provider Identifier
1811930076
Registry record updated Jul 21, 2026
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
3080 Highway 15-401 E
MC Coll, SC 29570-6128
Phone
(843) 523-5751
NPI assigned
Jun 14, 2006
Last updated
Jul 21, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2026

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

3080 Highway 15-401 E
MC Coll, SC 29570-6128

Mailing address

PO Box 1090
Hartsville, SC 29551-1090

Other identifiers 1

IdentifierTypeStateIssuer
FQC063MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL https://www.medfusion.net/caresouthcarolina-24591/portal/#/user/login

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030530000010 SC Part A Provider - Federally Qualified Health Center (FQHC) 1052221314 Practice locations: MC Coll, SC
O20040511000280 SC Part B Supplier - Clinic/Group Practice 1052221314 Receives reassigned benefits from 95 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Society Hill, SC; MC Coll, SC; Latta, SC; Lake View, SC; Hartsville, SC; Dillon, SC; Chesterfield, SC; Cheraw, SC…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811930076. Details of each certification follow.

Federally qualified health center certification: CCN 421881

Legal name
CARESOUTH CAROLINA INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 8, 2003
Last certification
Sep 8, 2003
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 5, 1978 in SC
Enrollment address
3080 Highway 15-401 E
MC Coll, SC 29570-6128

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

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

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 DirectorBoard Member Apr 7, 1978
Ennis R Bryant Individual Corporate DirectorBoard Member-Vice Chairperson Jan 1, 1992
Flossie W Bartell Individual Corporate DirectorBoard Member-Treasurer Jun 26, 2003
Teresa Gainey Individual Corporate OfficerBoard Member Dec 19, 2019
Ann Marie Lewis Individual Corporate Officer Jul 10, 2003
W-2 Managing EmployeeCeo Jul 10, 2003
Trudy Drawhorn Individual Corporate OfficerBoard Member Jul 27, 2017
Earnestine S Powe Individual Corporate DirectorBoard Member-Asst Secretary Jan 1, 1984
Patricia M Henegan Individual Corporate OfficerBoard Member Jul 27, 2017
Dorothy S Joyner Individual Corporate DirectorBoard Member Jan 1, 1996
Gene T Harper Individual OtherBoard Member Oct 16, 2023
Bonnie M Seals Individual Corporate DirectorBoard Member-Secretary Jan 1, 1996
Mary D Legrant Individual Corporate DirectorBoard Member Jan 1, 1996
Jay S Hodge Individual Corporate DirectorBoard Member-Chairperson Jan 1, 1998

Practitioners & affiliated clinicians

Practitioners 11

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": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784592000000",
    "number": "1811930076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1090",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295511090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3080 HIGHWAY 15-401 E",
            "city": "MC COLL",
            "state": "SC",
            "postal_code": "295706128",
            "telephone_number": "843-523-5751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARESOUTH CAROLINA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2026-07-21",
        "certification_date": "2026-07-21",
        "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": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC063",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.medfusion.net/caresouthcarolina-24591/portal/#/user/login",
            "affiliation": "N",
            "endpointDescription": "Patient Portal",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Patient Portal",
            "address_1": "3080 Highway 15-401 E",
            "city": "Mc Coll",
            "state": "SC",
            "country_code": "US",
            "postal_code": "295706128",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in McColl, SC

Sources for this page

Verify at the official NPI Registry.