NPIMap

Organization Active NPI

Low Country Health Care System, Inc

Doing business as Williston Family Medicine

  • Federally Qualified Health Center (FQHC)
  • Williston, SC
National Provider Identifier
1922468826
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LOW COUNTRY HEALTH CARE SYSTEM, INC
Doing business as
Williston Family Medicine
Practice address
13649 Church St
Williston, SC 29853-5835
Phone
(803) 266-0060
Fax
(803) 266-0065
NPI assigned
Mar 4, 2016
Last updated
Jan 11, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
LOW COUNTRY HEALTH CARE SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Authorized official

Name
Ashley Barnes
Title
Ceo
Phone
(803) 632-2533

Specialties & licenses 1

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

Addresses

Primary practice location

13649 Church St
Williston, SC 29853-5835

Mailing address

86 Wren St
Barnwell, SC 29812-1529
Phone (803) 259-5762

Other identifiers 1

IdentifierTypeStateIssuer
FQC#198MedicaidSC

Other names 1

  • Williston Family Medicine Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031211000944 SC Part B Supplier - Clinic/Group Practice 4284530940 Receives reassigned benefits from 55 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Aiken, SC; Barnwell, SC; Fairfax, SC; Williston, SC
O20160603001563 SC Part A Provider - Federally Qualified Health Center (FQHC) 4284530940 Practice locations: Williston, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922468826. Details of each certification follow.

Federally qualified health center certification: CCN 421040

Legal name
LOW COUNTRY HEALTH CARE SYSTEM INC
Doing business as
WILLISTON FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 3, 2016
Last certification
Jun 3, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 8, 1997 in SC
Enrollment address
13649 Church St
Williston, SC 29853

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 3

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
42D2109757Williston Family Medicine13649 Church Street, Williston, SC 29853Certificate of waiverApr 28, 2028

National Provider Directory

National Provider Directory
Tax ID family
Lowcountry Health Care9 organizations share this tax ID, including this one
Part of
Lowcountry Health Care

Other organizations with this tax ID 8

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

Locations

13975 Church St
Williston, SC 29853
Phone (803) 266-0060

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Ashley L Barnes Individual Corporate OfficerChief Executive Officer Oct 11, 2011 100%
Hope Rhule Individual W-2 Managing Employee Oct 1, 2020
Darainey Hudson Individual W-2 Managing EmployeeChief Compliance Officer Jul 31, 1989 75%

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Barnwell PediatricsBarnwell, SC, CCN 421043 Federally qualified health center Operational/Managerial Control May 1, 2014
Padgett Family PracticeBamberg, SC, CCN 421056 Federally qualified health center Operational/Managerial Control (100%) May 1, 2018
Aiken Specialty ServicesAiken, SC, CCN 421067 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2019

Owned or controlled facilities with NPI records 3

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

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": "1457049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1922468826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 WREN ST",
            "city": "BARNWELL",
            "state": "SC",
            "postal_code": "298121529",
            "telephone_number": "803-259-5762",
            "fax_number": "803-259-3250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13649 CHURCH ST",
            "city": "WILLISTON",
            "state": "SC",
            "postal_code": "298535835",
            "telephone_number": "803-266-0060",
            "fax_number": "803-266-0065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOW COUNTRY HEALTH CARE SYSTEM, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LOW COUNTRY HEALTH CARE SYSTEM",
        "enumeration_date": "2016-03-04",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "BARNES",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-632-2533"
    },
    "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#198",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Williston Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Williston Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williston, SC

Sources for this page

Verify at the official NPI Registry.