NPIMap

Organization Active NPI

Lake City Family Medicine, LLC

  • Rural Health Clinic/Center
  • Kingstree, SC
National Provider Identifier
1831445998
Registry record updated Oct 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
17100 Issued in SC
Legal business name
LAKE CITY FAMILY MEDICINE, LLC
Practice address
505 Thurgood Marshall Hwy
Kingstree, SC 29556-4107
Phone
(843) 374-8380
NPI assigned
Jul 26, 2012
Organization subpart
Yes
Parent organization
LAKE CITY FAMILY MEDICINE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 11, 2012

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

Authorized official

Name
Dr. Morris Edward Brown III, M.D.NPI 1801992599
Title
Owner
Phone
(843) 374-8380

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 17100 SC Primary

Addresses

Primary practice location

505 Thurgood Marshall Hwy
Kingstree, SC 29556-4107

Mailing address

901 N Matthews Rd
Lake City, SC 29560-7024
Phone (843) 374-5247

Other names 1

  • Family Medicine Associates, LLC Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070628000620 SC Part B Supplier - Clinic/Group Practice 0547368441 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kingstree, SC; Lake City, SC
O20121119000364 SC Part A Provider - Rural Health Clinic 0547368441 Practice locations: Kingstree, SC

Rural health clinic certification: CCN 423888

Legal name
LAKE CITY FAMILY MEDICINE LLC
Doing business as
FAMILY MEDICINE ASSOCIATES LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 22, 2013
Last certification
Feb 23, 2022
Ownership / control type
2B
Organization structure
LLCProprietary
Enrollment address
505 Thurgood Marshall Blvd
Kingstree, SC 29556-4107

Other NPIs with the same Medicare PAC ID 1

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.

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
42D2038395Family Medicine Associates, LLC505 Thurgood Marshall Blvd, Kingstree, SC 29556Provider-performed microscopyMar 19, 2028

National Provider Directory

National Provider Directory
Tax ID family
Lake City Family Medicine3 organizations share this tax ID, including this one
Part of
Lake City Family Medicine

Other organizations with this tax ID 2

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

Locations

901 N Matthews Rd
Lake City, SC 29560
Phone (843) 374-8380

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
Alyce Burgess Individual W-2 Managing EmployeeOffice Manager Aug 1, 2012 25%
Morris E Brown Individual 5% Or Greater Direct Ownership Interest Aug 1, 2012 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1343260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349913600000",
    "number": "1831445998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 N MATTHEWS RD",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295607024",
            "telephone_number": "843-374-5247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 THURGOOD MARSHALL HWY",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "295564107",
            "telephone_number": "843-374-8380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CITY FAMILY MEDICINE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKE CITY FAMILY MEDICINE, LLC",
        "enumeration_date": "2012-07-26",
        "last_updated": "2012-10-11",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "MORRIS",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-374-8380",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "SC",
            "license": "17100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine Associates, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kingstree, SC

Sources for this page

Verify at the official NPI Registry.