NPIMap

Organization Active NPI

Careteam Plus, Inc.

  • Federally Qualified Health Center (FQHC)
  • Pawley's Island, SC
National Provider Identifier
1902673130
Registry record updated Dec 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CARETEAM PLUS, INC.
Practice address
239 Business Center Dr
Pawleys Island, SC 29585-6522
Phone
(843) 234-0005
NPI assigned
Dec 7, 2023
Last updated
Dec 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2024

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

Authorized official

Name
Johanna L HaynesNPI 1356002109
Title
Ceo
Phone
(843) 234-8220

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Internal Medicine Physician 207R00000X
Pediatrics Physician 208000000X

Addresses

Primary practice location

239 Business Center Dr
Pawleys Island, SC 29585-6522

Mailing address

100 Professional Park Dr
Conway, SC 29526-9260
Phone (843) 234-0005

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120106000726 SC Part B Supplier - Clinic/Group Practice 2961678289 Receives reassigned benefits from 16 practitioners
2 other NPIs on this enrollment
Practice locations: Conway, SC; Georgetown, SC; Pawleys Island, SC
O20240308001876 SC Part A Provider - Federally Qualified Health Center (FQHC) 2961678289 Practice locations: Pawleys Island, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902673130. Details of each certification follow.

Federally qualified health center certification: CCN 421095

Legal name
CARETEAM PLUS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 12, 2024
Last certification
Mar 12, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 24, 1994 in SC
Enrollment address
239 Business Center Dr
Pawleys Island, SC 29585-6522

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Careteam Plus Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

239 Business Center Dr
Pawleys Island, SC 29585
Phone (843) 234-0005

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
Johanna Haynes Individual Corporate Director Apr 1, 2011
W-2 Managing Employee Apr 1, 2011
Careteam Plus Inc Organization, Conway, SC Non-profit 5% Or Greater Direct Ownership Interest Jun 20, 2018 100%

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Careteam Plus IncConway, SC, CCN 421057 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 20, 2018

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1701907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734566400000",
    "number": "1902673130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PROFESSIONAL PARK DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295269260",
            "telephone_number": "843-234-0005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "239 BUSINESS CENTER DR",
            "city": "PAWLEYS ISLAND",
            "state": "SC",
            "postal_code": "295856522",
            "telephone_number": "843-234-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARETEAM PLUS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-07",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "JOHANNA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-234-8220"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pawley's Island, SC

Sources for this page

Verify at the official NPI Registry.