NPIMap

Organization Active NPI

Regenesis Organization Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Union, SC
National Provider Identifier
1982248852
Registry record updated Jan 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
REGENESIS ORGANIZATION COMMUNITY HEALTH CENTER
Practice address
115 Thomas St Ste B
Union, SC 29379-2147
Phone
(864) 582-2411
Fax
(864) 256-4336
NPI assigned
Nov 4, 2019
Organization subpart
Yes
Parent organization
REGENESIS ORGANIZATION COMMUNITY HEALTH CENTERAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Lois J Menken
Title
Credentialing Specialist
Phone
(864) 594-0175

Other NPIs with the same Medicare PAC ID 8

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

Practitioners 106

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 106

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200608002096 SC Part A Provider - Federally Qualified Health Center (FQHC) 8022928001 Practice locations: Union, SC
O20210120001241 SC Part B Supplier - Clinic/Group Practice 8022928001 Receives reassigned benefits from 71 practitioners
Practice locations: Union, SC

Federally qualified health center certification: CCN 421076

Legal name
REGENESIS ORGANIZATION COMMUNITY HEALTH CENTER
Doing business as
UNION MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 8, 2020
Last certification
Jun 8, 2020
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 3, 1998 in SC
Enrollment address
115 Thomas St
Ste B
Union, SC 29379-2147

All disclosed owners & managing parties 1

Medicare enrollment files

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

NameRoleSinceShare
Marlon Hunter Individual Corporate DirectorCeo Aug 13, 2018 100%
W-2 Managing EmployeeCeo Aug 13, 2018 100%

National Provider Directory

National Provider Directory
Part of
Regenesis Organization

Locations

115 Thomas St
#B
Union, SC 29379

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

115 Thomas St Ste B
Union, SC 29379-2147

Mailing address

PO Box 5158
Spartanburg, SC 29304-5158
Phone (864) 582-2817

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 7, 2020.

{
    "created_epoch": "1572825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578355200000",
    "number": "1982248852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5158",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293045158",
            "telephone_number": "864-582-2817",
            "fax_number": "864-582-2829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 THOMAS ST STE B",
            "city": "UNION",
            "state": "SC",
            "postal_code": "293792147",
            "telephone_number": "864-582-2411",
            "fax_number": "864-256-4336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENESIS ORGANIZATION COMMUNITY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REGENESIS ORGANIZATION COMMUNITY HEALTH CENTER",
        "enumeration_date": "2019-11-04",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A",
        "authorized_official_last_name": "MENKEN",
        "authorized_official_first_name": "LOIS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "864-594-0175"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Union, SC

Sources for this page

Verify at the official NPI Registry.