HALO PRIMARY CARE, LLC
NPI 1639844509
Nurse Practitioner - Primary Care in Okatie, SC
About Halo Primary Care, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
HALO PRIMARY CARE, LLC (NPI 1639844509) is a healthcare organization registered as a primary care in Okatie, South Carolina and active in the NPI registry since August 2021. The organization holds a CLIA Waiver certificate valid through February 29, 2028 and lists Bethany Gaultney, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Halo Primary Care, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by February 28, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Halo Primary Care, LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
West Columbia, SC 29169
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 42D2254141
Halo Primary Care, LLC · Okatie, SCFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Halo Primary Care, LLC's NPI number?
The NPI number for Halo Primary Care, LLC is 1639844509. It was assigned to this organization in the NPPES registry on August 12, 2021.
Where is Halo Primary Care, LLC located?
Halo Primary Care, LLC is located at 40 Okatie Ctr Blvd Ste 215, Okatie, SC 29909. The listed phone number is (256) 453-6074.
What is Halo Primary Care, LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.
Is Halo Primary Care, LLC enrolled in Medicare?
Yes. Halo Primary Care, LLC is registered in the Medicare PECOS enrollment system.
When is Halo Primary Care, LLC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (South Carolina, Clinic/Group Practice) is due for revalidation by February 28, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Halo Primary Care, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Halo Primary Care, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Halo Primary Care, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 42D2254141) is associated with this NPI, valid through February 29, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Halo Primary Care, LLC was last updated on October 8, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Halo Primary Care, Llc · NPI 1639844509
Primary Care organization in Okatie, South Carolina. Organization record, active in the CMS NPPES registry since August 12, 2021.
## Identity
- **NPI:** 1639844509 (Entity type: Organization)
- **Enumerated:** August 12, 2021
- **Primary specialty:** Nurse Practitioner - Primary Care · taxonomy 363LP2300X
- **Organization subpart:** No
- **Authorized official:** Bethany Gaultney, OWNER
## Practice location
- **Address:** 40 OKATIE CTR BLVD STE 215, Okatie, SC 29909-7507
- **Phone:** (256) 453-6074
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** February 28, 2027 (Non-DME Part B, South Carolina, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 2 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 8, 2025
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1639844509) · Data from the CMS NPPES public registry.