NPIMap

Organization Active NPI

Beaufort Jasper Hampton Comprehensive Health Services, Inc.

Doing business as Port Royal Medical Center

  • Federally Qualified Health Center (FQHC)
  • Port Royal, SC
National Provider Identifier
1942554886
Registry record updated Aug 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
FQC102 Issued in SC
Legal business name
BEAUFORT JASPER HAMPTON COMPREHENSIVE HEALTH SERVICES, INC.
Doing business as
Port Royal Medical Center
Practice address
1320 Ribaut Rd
Port Royal, SC 29935-1118
Phone
(843) 986-0900
Fax
(843) 986-0566
NPI assigned
Oct 30, 2012
Last updated
Aug 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2022

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

Authorized official

Name
Mr. Roland J Gardner
Title
Chief Executive Officer
Phone
(843) 987-7400

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X GP2554 SC
Dental Clinic/Center 261QD0000X 295441 SC
Federally Qualified Health Center (FQHC) 261QF0400X FQC102 SC Primary
Multi-Specialty Clinic/Center 261QM1300X CBP005 SC
Medical Specialty Clinic/Center 261QM2500X FQC102 SC
Mammography Clinic/Center 261QR0206X

Addresses

Primary practice location

1320 Ribaut Rd
Port Royal, SC 29935-1118

Mailing address

721 N Okatie Hwy # 170
Ridgeland, SC 29936-8276
Phone (843) 987-7400

Other identifiers 1

IdentifierTypeStateIssuer
FQC102MedicaidSC

Other names 1

  • Port Royal Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091014000281 SC Part A Provider - Federally Qualified Health Center (FQHC) 5597675728 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Port Royal, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942554886. Details of each certification follow.

Federally qualified health center certification: CCN 421915

Legal name
BEAUFORT JASPER HAMPTON COMPREHENSIVE HEALTH SERVICES INC
Doing business as
PORT ROYAL MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Jan 10, 1970 in SC
Enrollment address
1320 South Ribaut Raod
Port Royal, SC 29935-1118

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Bjhchs Inc24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

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

View all 23

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Carolyn Theodore Individual Corporate Director Nov 29, 2012
Lucy Robinson Individual Corporate Director Nov 29, 2012
Hattie O Askew Individual Corporate Director Nov 29, 2012
Delmer Hollingsworth Individual Corporate Director Nov 29, 2012
Roland J Gardner Individual Corporate Director Sep 21, 2009
Kimberly R McMillan Individual Corporate Director Nov 29, 2012
June Levesque Individual Corporate Director Sep 21, 2009
Beaufort Jasper Hampton Comprehensive Health Services Inc Organization, Okatie, SC Non-profit Operational/Managerial Control Sep 21, 2009
Clareatha Dreissen Individual W-2 Managing Employee Sep 21, 2009
Christopher Yenchko Individual Corporate Director Nov 29, 2012
Pablo Caballero Individual Corporate Director Nov 29, 2012
Baxter F McLendon Individual Corporate Director Nov 29, 2012
Martha Johnson Individual Corporate Director Nov 29, 2012

Owners & managing parties with NPI records 10

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

NPI Registry JSON

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

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660003200000",
    "number": "1942554886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 N OKATIE HWY # 170",
            "city": "RIDGELAND",
            "state": "SC",
            "postal_code": "299368276",
            "telephone_number": "843-987-7400",
            "fax_number": "843-987-7498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 RIBAUT RD",
            "city": "PORT ROYAL",
            "state": "SC",
            "postal_code": "299351118",
            "telephone_number": "843-986-0900",
            "fax_number": "843-986-0566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAUFORT JASPER HAMPTON COMPREHENSIVE HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-30",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "ROLAND",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "843-987-7400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "SC",
            "license": "GP2554",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "SC",
            "license": "295441",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "SC",
            "license": "FQC102",
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "SC",
            "license": "CBP005",
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "SC",
            "license": "FQC102",
            "primary": false
        },
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC102",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Port Royal Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Port Royal Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Royal, SC

Sources for this page

Verify at the official NPI Registry.