NPIMap

Organization Active NPI

Fetter Health Care Network, Inc.

Doing business as One 80 Place

  • Federally Qualified Health Center (FQHC)
  • Charleston, SC
National Provider Identifier
1982124301
Registry record updated Jun 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FETTER HEALTH CARE NETWORK, INC.
Doing business as
One 80 Place
Practice address
35 Walnut St
Charleston, SC 29403-4514
Phone
(843) 722-4112
NPI assigned
Jun 27, 2017
Last updated
Jun 27, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
FETTER HEALTH CARE NETWORK, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 27, 2017

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

Authorized official

Name
Aretha Jones
Title
Ceo
Phone
(843) 722-4112

Specialties & licenses 1

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

Addresses

Primary practice location

35 Walnut St
Charleston, SC 29403-4514

Mailing address

51 Nassau St
Charleston, SC 29403-5513
Phone (843) 722-4112

Other names 1

  • One 80 Place Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20171006002377 SC Part A Provider - Federally Qualified Health Center (FQHC) 9032215199 Practice locations: Charleston, SC
O20171228002000 SC Part B Supplier - Clinic/Group Practice 9032215199 Receives reassigned benefits from 71 practitioners
Practice locations: Charleston, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982124301. Details of each certification follow.

Federally qualified health center certification: CCN 421051

Legal name
FETTER HEALTH CARE NETWORK INC
Doing business as
ONE 80 PLACE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 6, 2017
Last certification
Oct 6, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 8, 1975 in SC
Enrollment address
35 Walnut Street
Charleston, SC 29403

Other NPIs with the same Medicare PAC ID 14

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

View all 14

National Provider Directory

National Provider Directory
Part of
Franklin C Fetter Family Health Center Inc

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Darlene E Wright Individual Corporate OfficerBoard Member Jan 1, 2014
Enid B Jenkins Individual Corporate OfficerBoard Member Jan 1, 2014
Aretha Powers Individual Corporate DirectorCeo Apr 11, 2016
W-2 Managing EmployeeCeo Aug 16, 2017
Sonya B Jones Individual Corporate OfficerBoard Member Jan 1, 2014
Deborah C Williamson Individual Corporate OfficerBoard Member Jan 1, 2014
Phalarma Freeman Individual Corporate OfficerBoard Member Jan 1, 2014

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Fetter Health Care Network IncCharleston, SC, CCN 421044 Federally qualified health center Operational/Managerial Control (100%) Sep 18, 2014

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 72

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 72

NPI Registry JSON

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

{
    "created_epoch": "1498521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498521600000",
    "number": "1982124301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 NASSAU ST",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294035513",
            "telephone_number": "843-722-4112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 WALNUT ST",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294034514",
            "telephone_number": "843-722-4112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FETTER HEALTH CARE NETWORK, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FETTER HEALTH CARE NETWORK, INC.",
        "enumeration_date": "2017-06-27",
        "last_updated": "2017-06-27",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "ARETHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-722-4112"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "One 80 Place",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "One 80 Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.