NPIMap

Organization Active NPI

St. James Health and Wellness Inc.

Doing business as Georgetown Pediatric Center

  • Federally Qualified Health Center (FQHC)
  • Georgetown, SC
National Provider Identifier
1316345846
Registry record updated Jun 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ST. JAMES HEALTH AND WELLNESS INC.
Doing business as
Georgetown Pediatric Center
Practice address
57 Jessamine Ave
Georgetown, SC 29440-5837
Phone
(843) 887-3274
Fax
(843) 887-3274
NPI assigned
Dec 16, 2014
Last updated
Jun 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2022

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

Authorized official

Name
Mrs. Sandra D Gilliard, MBA
Title
Ceo
Phone
(184) 399-0799

Specialties & licenses 1

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

Addresses

Primary practice location

57 Jessamine Ave
Georgetown, SC 29440-5837

Mailing address

PO Box 608
MC Clellanville, SC 29458-0608
Phone (843) 887-3274

Other practice location 1

1189 Tibwin Rd
Mc Clellanville, SC 29458-9405
Phone (843) 990-7993

Other names 1

  • Georgetown Pediatric Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150212002144 SC Part A Provider - Federally Qualified Health Center (FQHC) 1658280334 Practice locations: Georgetown, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316345846. Details of each certification follow.

Federally qualified health center certification: CCN 421022

Legal name
ST JAMES HEALTH AND WELLNESS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 13, 2015
Last certification
Feb 13, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1981 in SC
Enrollment address
57 Jessamine Ave
Georgetown, SC 29440-5837

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
St James-Santee Family Heal9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Charles W Johnson Individual 5% Or Greater Direct Ownership InterestBoard Chairman Oct 1, 2008 5%
Sandra D. Gilliard Individual W-2 Managing EmployeeCeo Jul 2, 2011 100%
Henry L Mellichamp Individual Corporate DirectorBoard Member Jun 1, 2019 100%
Joyce Cox Holmes Individual Corporate DirectorBoard Member Jan 2, 2018 100%
Hessie Richard Individual 5% Or Greater Indirect Ownership InterestChairman Jan 30, 2024 100%

NPI Registry JSON

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

{
    "created_epoch": "1418688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655769600000",
    "number": "1316345846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 608",
            "city": "MC CLELLANVILLE",
            "state": "SC",
            "postal_code": "294580608",
            "telephone_number": "843-887-3274",
            "fax_number": "842-887-3817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 JESSAMINE AVE",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294405837",
            "telephone_number": "843-887-3274",
            "fax_number": "843-887-3274"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1189 Tibwin Rd",
            "address_purpose": "LOCATION",
            "city": "Mc Clellanville",
            "state": "SC",
            "postal_code": "294589405",
            "country_code": "US",
            "telephone_number": "843-990-7993",
            "fax_number": "843-887-3817",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST. JAMES HEALTH AND WELLNESS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-16",
        "last_updated": "2022-06-21",
        "certification_date": "2022-06-21",
        "status": "A",
        "authorized_official_last_name": "GILLIARD",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "184-399-0799",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MBA"
    },
    "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": "Georgetown Pediatric Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Georgetown, SC

Sources for this page

Verify at the official NPI Registry.