NPIMap

Organization Active NPI

Eau Claire Cooperative Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Columbia, SC
National Provider Identifier
1992018949
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC
Practice address
4605 Monticello Rd
Building B, Ste.1
Columbia, SC 29203-4156
Phone
(803) 714-0266
Fax
(803) 753-6333
NPI assigned
Jul 20, 2010
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Delgado Cantave, MD
Title
Ceo
Phone
(803) 733-5969

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
42D2048687Eau Claire Behavioral Medicine4605 Monticello Road, Building B, Suite 1, Columbia, SC 29203Certificate of waiverOct 21, 2026

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101013000458 SC Part a Provider - Federally Qualified Health Center (FQHC) 3274434220 Practice locations: Columbia, SC

Federally qualified health center certification: CCN 421861

Medicare enrollment files
Legal name
EAU CLAIRE COOPERATIVE HEALTH CENTER, INC.
Doing business as
EAU CLAIRE BEHAVIORAL MEDICINE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 8, 2000
Last certification
May 8, 2000
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Dec 14, 1992 in SC
Enrollment address
4605 Monticello Road
Building B, Suite 1
Columbia, SC 29203-4156

All disclosed owners & managing parties 15

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
Hasan Ross-El Individual Corporate DirectorVice Chair Apr 1, 2019
Bernice Kennedy Individual Corporate Director May 1, 2014
Craig Currey Individual Corporate DirectorTreasurer Jul 1, 2014
Ashley Jackson Individual Corporate Director Jun 1, 2013
Deborah Depaoli Individual Corporate DirectorSecretary Jun 1, 2017
Dean Slade Individual Corporate Director Jul 1, 2017
Karena S White Individual Corporate Officer Dec 21, 2020
W-2 Managing Employee Dec 21, 2020
Junior Delgado Cantave Individual Corporate Officer Sep 28, 2016
W-2 Managing Employee Sep 28, 2016
Julia Easterlin Individual Corporate Director Jul 1, 2013
Julie Smithwick Individual Corporate Director Sep 1, 2016
Glenn Stalions Individual Corporate Director May 1, 2016
Generett Dingle Individual Corporate Director Feb 1, 2018
Elaine Eskew Individual Corporate Director Jun 1, 2019
Gregory Torrales Individual Corporate DirectorBoard Chair Mar 1, 2014
Rafael Gonzalez Individual Corporate Director Dec 1, 2021

All facility ownership & control disclosures 14

Medicare enrollment files

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

FacilityTypeRoleSince
Eau Claire Cooperative Health Center, Inc.Columbia, SC, CCN 421843 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2019
Eastover Family PracticeEastover, SC, CCN 421960 Federally qualified health center Operational/Managerial Control Jan 26, 2012
Pediatrics of NewberryNewberry, SC, CCN 421970 Federally qualified health center 5% Or Greater Direct Ownership Interest Jul 1, 2014
Waverly Women'S Health & Internal MedicineBatesburg Leesville, SC, CCN 421974 Federally qualified health center 5% Or Greater Direct Ownership Interest Jun 1, 2010
Eau Claire PodiatryColumbia, SC, CCN 421968 Federally qualified health center 5% Or Greater Direct Ownership Interest Mar 7, 2022
Sterling Sharpe PediatricsSuite 1, SC, CCN 421972 Federally qualified health center 5% Or Greater Direct Ownership Interest Nov 4, 2014
Pelion Pediatrics Family & DentalPelion, SC, CCN 421977 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 19, 2012
Brookland Community PediatricsWest Columbia, SC, CCN 421978 Federally qualified health center 5% Or Greater Direct Ownership Interest Jul 1, 2010
Pediatrics of Batesburg-LeesburgBatesburg-Leesville, SC, CCN 421980 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 30, 2012
Eau Claire Walk-inColumbia, SC, CCN 421023 Federally qualified health center 5% Or Greater Direct Ownership Interest Mar 7, 2022
Five Points Behavioral Health at Hand Middle SchoolColumbia, SC, CCN 421064 Federally qualified health center Operational/Managerial Control Jan 1, 2016
Eau Claire Cooperative Health Center, Inc.Little Mountain, SC, CCN 421068 Federally qualified health center Operational/Managerial Control Jan 1, 2016
Columbia Community Family PracticeColumbia, SC, CCN 871035 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2016
Advantage Eye CareColumbia, SC, CCN 871038 Federally qualified health center 5% Or Greater Direct Ownership Interest Jun 1, 2022

National Provider Directory

National Provider Directory
Tax ID family
Eau Claire Cooperative Health Center Inc42 organizations share this tax ID, including this one

Other organizations with this tax ID 41

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

View all 41

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

4605 Monticello Rd
Building B, Ste.1
Columbia, SC 29203-4156

Mailing address

PO Box 3788
Columbia, SC 29230-3788
Phone (803) 753-5591

Other identifiers 3

NPPES NPI Registry
IdentifierTypeStateIssuer
FQC187MedicaidSC
CBP018MedicaidSC
FQC031MedicaidSC

Other names 1

NPPES NPI Registry
  • Eau Claire Behavioral Medicine Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 10, 2022.

{
    "created_epoch": "1279584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1992018949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3788",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292303788",
            "telephone_number": "803-753-5591",
            "fax_number": "803-753-5591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 MONTICELLO RD",
            "address_2": "BUILDING B, STE.1",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292034156",
            "telephone_number": "803-714-0266",
            "fax_number": "803-753-6333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAU CLAIRE COOPERATIVE HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-20",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "CANTAVE",
        "authorized_official_first_name": "DELGADO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-733-5969",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC187",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CBP018",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC031",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eau Claire Behavioral Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eau Claire Behavioral Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.