NPIMap

Organization Active NPI

Community Medicine Foundation

Doing business as NCFMC Peditric and Adolescent Center

  • Federally Qualified Health Center (FQHC)
  • Rock Hill, SC
National Provider Identifier
1902173891
Registry record updated Dec 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY MEDICINE FOUNDATION
Doing business as
NCFMC Peditric and Adolescent Center
Practice address
225 S Herlong Ave
Suite 250
Rock Hill, SC 29732-2730
Phone
(803) 325-8742
Fax
(803) 325-2369
NPI assigned
Nov 21, 2011
Last updated
Dec 6, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2011

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

Authorized official

Name
Mr. Ernest G. Brown
Title
Executive Director
Phone
(803) 325-7744

Specialties & licenses 1

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

Addresses

Primary practice location

225 S Herlong Ave
Suite 250
Rock Hill, SC 29732-2730

Mailing address

PO Box 28
Rock Hill, SC 29731-6028
Phone (803) 325-7744

Other identifiers 1

IdentifierTypeStateIssuer
FQC-025MedicaidSC

Other names 1

  • NCFMC Peditric and Adolescent Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040407001159 SC Part B Supplier - Clinic/Group Practice 4880687490 Receives reassigned benefits from 19 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chester, SC; Rock Hill, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902173891. Details of each certification follow.

  • CCN 421954 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 421954

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
NCFMC PEDIATRIC AND ADOLESCENT CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 28, 2012
Last certification
Mar 28, 2012
Ownership / control type
For profit – corporation
Facility address
225 South Herlong Avenue, Suite 250
Rock Hill, SC 29732

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Locations

225 Herlong Ave S
Ste 250
Rock Hill, SC 29732
Phone (803) 325-8742

Practitioners & affiliated clinicians

Practitioners 4

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": "1321833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323129600000",
    "number": "1902173891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 28",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297316028",
            "telephone_number": "803-325-7744",
            "fax_number": "803-325-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 S HERLONG AVE",
            "address_2": "SUITE 250",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297322730",
            "telephone_number": "803-325-8742",
            "fax_number": "803-325-2369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEDICINE FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-21",
        "last_updated": "2011-12-06",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "ERNEST",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "803-325-7744",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC-025",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NCFMC Peditric and Adolescent Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rock Hill, SC

Sources for this page

Verify at the official NPI Registry.