NPIMap

Organization Active NPI

Genesis Healthcare, Inc.

Doing business as Mobile Health Clinic #1

  • Federally Qualified Health Center (FQHC)
  • Walterboro, SC
National Provider Identifier
1881440758
Registry record updated Aug 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GENESIS HEALTHCARE, INC.
Doing business as
Mobile Health Clinic #1
Practice address
830 Robertson Blvd
Walterboro, SC 29488-3081
Phone
(843) 584-4353
Fax
(803) 254-3678
NPI assigned
Apr 30, 2024
Last updated
Aug 10, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2026

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

Authorized official

Name
Tony Megna
Title
Ceo
Phone
(803) 254-3676

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

830 Robertson Blvd
Walterboro, SC 29488-3081

Mailing address

8906 Two Notch Rd
Columbia, SC 29223-6366
Phone (803) 254-3676

Other names 1

  • Mobile Health Clinic #1 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250401002573 SC Part A Provider - Federally Qualified Health Center (FQHC) 4688869696 Practice locations: Walterboro, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881440758. Details of each certification follow.

Federally qualified health center certification: CCN 421114

Legal name
GENESIS HEALTHCARE, INC
Doing business as
MOBILE HEALTH CLINIC #1
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 17, 2025
Last certification
Mar 17, 2025
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Mar 26, 2009 in SC
Enrollment address
457 Spruce St
Walterboro, SC 29488-2766

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
Genesis Healthcare Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

115 Exchange St
Darlington, SC 29532
Phone (843) 393-9421

99 Bridgetown Rd
Goose Creek, SC 29445
Phone (843) 572-3300

830 Robertson Blvd
Walterboro, SC 29488
Phone (843) 781-7428

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Karen Lee Individual Corporate DirectorBoard Member Feb 18, 2021
Michael McManus Individual Corporate DirectorBoard Member Feb 18, 2021
Nathan Prabhakar Individual Corporate OfficerExecutive Finance Officer Jan 1, 2023
W-2 Managing Employee Jan 1, 2023
Roosevelt Scott Individual Corporate DirectorBoard Member- Treasurer Jan 1, 2018
Tony Megna Individual Corporate OfficerCeo Oct 22, 2010
W-2 Managing Employee Oct 22, 2010
Jennifer Powell Individual Corporate DirectorBoard Member Mar 21, 2019
Genesis Healthcare, Inc Organization, Columbia, SC Non-profit Operational/Managerial Control Mar 26, 2009
Thomas Sawyer Individual Corporate DirectorBoard Member Jul 21, 2011
Wilbur Coleman Individual Corporate DirectorBoard Member Nov 17, 2022
Althia Manuel Individual Corporate OfficerClinical Revenue Cycle Officer Jan 1, 2024
W-2 Managing Employee Jan 1, 2024
John Kimbrough Individual Corporate DirectorBoard Member- Secretary Oct 19, 2023
Cheri Fowler Individual Corporate OfficerChief Communications Officer Jan 1, 2024
W-2 Managing Employee Jan 1, 2024
David Corry Individual Corporate DirectorChairperson Oct 19, 2023
Ernestine Ferguson Individual Corporate DirectorBoard Member Nov 17, 2022
Kimberly Weatherford Individual Corporate OfficerChief Operating Officer Jan 1, 2024
W-2 Managing Employee Jan 1, 2024
Scott Eagerton Individual Corporate DirectorBoard Member Jun 20, 2019
Mal Hyman Individual Corporate DirectorBoard Member Nov 17, 2019
John Ramsey Individual Corporate DirectorBoard Member Jun 18, 2020

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Genesis Healthcare, IncDarlington, SC, CCN 421939 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Oct 4, 2010
Oct 4, 2010
Walterboro Family Care and PediatricsWalterboro, SC, CCN 421046 Federally qualified health center Operational/Managerial Control Mar 26, 2009
Mobile Health Clinic #2Columbia, SC, CCN 421112 Federally qualified health center Operational/Managerial Control Mar 26, 2009

Owned or controlled facilities with NPI records 3

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

  • Genesis Healthcare, Inc

    dba Walterboro Family Care and Pediatrics

    • Federally Qualified Health Center (FQHC)
    • Walterboro, SC
    • NPI 1942757844

    Operational/Managerial Control

    CMS ownership
  • Genesis Healthcare, Inc.

    dba Mobile Health Clinic #2

    • Federally Qualified Health Center (FQHC)
    • Darlington, SC
    • NPI 1346088879

    Operational/Managerial Control

    CMS ownership
  • Genesis Healthcare, Inc.

    dba Pee Dee Health Care

    • Federally Qualified Health Center (FQHC)
    • Darlington, SC
    • NPI 1437484862

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 38

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 38

NPI Registry JSON

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

{
    "created_epoch": "1714435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786320000000",
    "number": "1881440758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8906 TWO NOTCH RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292236366",
            "telephone_number": "803-254-3676",
            "fax_number": "803-254-3678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 ROBERTSON BLVD",
            "city": "WALTERBORO",
            "state": "SC",
            "postal_code": "294883081",
            "telephone_number": "843-584-4353",
            "fax_number": "803-254-3678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-30",
        "last_updated": "2026-08-10",
        "certification_date": "2026-08-10",
        "status": "A",
        "authorized_official_last_name": "MEGNA",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-254-3676"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mobile Health Clinic #1",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Walterboro, SC

Sources for this page

Verify at the official NPI Registry.