Eau Claire Cooperative Health Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Newberry, SC
NPI 1891007233 · NPPES record last updated Aug 14, 2025
Key facts
- NPI
- 1891007233
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
- Practice address
- 2525 Kinard St
Newberry, SC 29108-2909 - Phone
- (803) 405-0220
- Fax
- (803) 405-0222
- NPI assigned
- Jul 13, 2010
- Organization subpart
- No
Authorized official
- Name
- Kimberly M Tilley
- Title
- Sr. Credentialing Specialist
- Phone
- (804) 306-1203
Other NPIs on the same Medicare enrollment 23
Corporate family (same tax ID) 41
Facilities with the same owner 13
Practitioners 2
-
Dean A Floyd, M.D
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 42D1024863 | Pediatrics of Newberry | Provider-performed microscopy | Mar 30, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SC
Federally qualified health center certification: CCN 421970
- Legal name
- EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
- Doing business as
- PEDIATRICS OF NEWBERRY
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 7, 2012
- Last certification
- Sep 7, 2012
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 14, 1992 in SC
- Enrollment address
- 2525 Kinard Street
Newberry, SC 29108-2909
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Eau Claire Cooperative Health Center, Inc. |
5% Or Greater Direct Ownership Interest | Jul 1, 2014 | |
| Karena S White |
W-2 Managing Employee | Mar 1, 2022 | |
| Junior Delgado Cantave |
Contracted Managing Employee | Sep 28, 2016 | |
| Corporate Director | Sep 28, 2016 |
All facility ownership & control disclosures 13
| Facility | Type | Role | Since |
|---|---|---|---|
| Eau Claire Cooperative Health Center, Inc. |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Jan 1, 2019 |
| Eastover Family Practice |
Federally qualified health center | Operational/Managerial Control | Jan 26, 2012 |
| Waverly Women'S Health & Internal Medicine |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Jun 1, 2010 |
| Eau Claire Podiatry |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Mar 7, 2022 |
| Sterling Sharpe Pediatrics |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Nov 4, 2014 |
| Pelion Pediatrics Family & Dental |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Oct 19, 2012 |
| Brookland Community Pediatrics |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Jul 1, 2010 |
| Pediatrics of Batesburg-Leesburg |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Oct 30, 2012 |
| Eau Claire Walk-in |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Mar 7, 2022 |
| Five Points Behavioral Health at Hand Middle School |
Federally qualified health center | Operational/Managerial Control | Jan 1, 2016 |
| Eau Claire Cooperative Health Center, Inc. |
Federally qualified health center | Operational/Managerial Control | Jan 1, 2016 |
| Columbia Community Family Practice |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Jan 1, 2016 |
| Advantage Eye Care |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Jun 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040114000335 | SC | Part B Supplier - Clinic/Group Practice | 3274434220 |
Receives reassigned benefits from 153 practitioners 23 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Columbia, SC; Eastover, SC; Hopkins, SC; Jenkinsville, SC; Leesville, SC; Little Mountain, SC; Newberry, SC; Pelion, SC… |
| O20120824000564 | SC | Part a Provider - Federally Qualified Health Center (FQHC) | 3274434220 | Practice locations: Newberry, SC |
National Provider Directory
- Tax ID family
- Eau Claire Cooperative Health Center Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
2525 Kinard St
Newberry, SC 29108-2909
Mailing address
PO Box 3788
Columbia, SC 29230-3788
Phone (803) 753-5591
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| FQC031 | Medicaid | SC | |
| FQC131 | Medicaid | SC | |
| CBP018 | Medicaid | SC |
Other names
- Cooperative Health Newberry
Other providers in Newberry, SC
- Dennis R Drinkall
- Madeline Danielle Dutterer
- Stephen Federick Dyke
- E Washington Medical Services PC
- Eau Claire Cooperative Health Center ,Inc.
- Jessica Danielle Edwards
- William Bland Edwards
- Neil Ehlers
- Evon Y Eichelberger
- Empire Osteopathy, LLC
All providers in Newberry, SC · Federally Qualified Health Center (FQHC) in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.