NPIMap

Organization Active NPI

Conway Hospital Community Services

Doing business as CPG Family Medicine

  • Rural Health Clinic/Center
  • Aynor, SC
National Provider Identifier
1821335068
Registry record updated Dec 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CONWAY HOSPITAL COMMUNITY SERVICES
Doing business as
CPG Family Medicine
Practice address
51 11TH Ave
Aynor, SC 29511-3249
Phone
(843) 358-3700
Fax
(843) 358-3707
NPI assigned
Jan 8, 2013
Last updated
Dec 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2023

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

Authorized official

Name
Mary Ellen Artioli
Title
Credentialing Specialist
Phone
(843) 234-6946

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Medical Physician Assistant 363AM0700X
Family Nurse Practitioner 363LF0000X
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

51 11TH Ave
Aynor, SC 29511-3249

Mailing address

300 Singleton Ridge Rd
Attention PNS Credentialing
Conway, SC 29526-9142
Phone (843) 234-6946

Other identifiers 2

IdentifierTypeStateIssuer
RHC224MedicaidSC
GP6275MedicaidSC

Other names 1

  • CPG Family Medicine Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040316000313 SC Part B Supplier - Clinic/Group Practice 9830087774 Receives reassigned benefits from 7 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Aynor, SC
O20130531000475 SC Part A Provider - Rural Health Clinic 9830087774 Practice locations: Aynor, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821335068. Details of each certification follow.

Rural health clinic certification: CCN 423875

Legal name
CONWAY HOSPITAL COMMUNITY SERVICES
Doing business as
CPG FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 27, 2011
Last certification
Feb 1, 2023
Ownership / control type
2B
Most recent change of ownership
May 3, 2013 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Feb 8, 2001 in SC
Enrollment address
51 11TH Avenue
Aynor, SC 29511-3249

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 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D1106283CPG Family Medicine51 11TH Avenue, Aynor, SC 29511Certificate of waiverMay 21, 2027

National Provider Directory

National Provider Directory
Tax ID family
Conway Hospital Community Services8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

300 Singleton Ridge Rd
Conway, SC 29526
Phone (843) 234-6946

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
Brian J Argo Individual Contracted Managing Employee Jul 31, 2017
Corporate OfficerCfo Jul 31, 2017
Operational/Managerial ControlCeo Jan 1, 2023
Candice R Abbott Individual Contracted Managing EmployeeCfo Sep 1, 2025
Corporate OfficerCfo Sep 1, 2025
Operational/Managerial ControlCfo Sep 1, 2025

Practitioners & affiliated clinicians

Practitioners 2

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": "1357603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703721600000",
    "number": "1821335068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SINGLETON RIDGE RD",
            "address_2": "ATTENTION PNS CREDENTIALING",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295269142",
            "telephone_number": "843-234-6946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 11TH AVE",
            "city": "AYNOR",
            "state": "SC",
            "postal_code": "295113249",
            "telephone_number": "843-358-3700",
            "fax_number": "843-358-3707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONWAY HOSPITAL COMMUNITY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-08",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A",
        "authorized_official_last_name": "ARTIOLI",
        "authorized_official_first_name": "MARY ELLEN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "843-234-6946"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHC224",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP6275",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CPG Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CPG Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aynor, SC

Sources for this page

Verify at the official NPI Registry.