NPIMap

Organization Active NPI

Tandem Health SC

  • Federally Qualified Health Center (FQHC)
  • Sumter, SC
National Provider Identifier
1356772776
Registry record updated Oct 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TANDEM HEALTH SC
Practice address
319 N Main St
Sumter, SC 29150-4258
Phone
(803) 774-4500
Fax
(803) 305-1466
NPI assigned
Dec 11, 2013
Last updated
Oct 14, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
SUMTER FAMILY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 14, 2019

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

Authorized official

Name
Annie L Brown
Title
Ceo
Phone
(803) 774-4500

Specialties & licenses 1

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

Addresses

Primary practice location

319 N Main St
Sumter, SC 29150-4258

Mailing address

PO Box 250
Sumter, SC 29151-0250
Phone (803) 774-4500

Other identifiers 2

IdentifierTypeStateIssuer
42-1009OtherSCMEDICARE PROVIDER NUMBER
7124OtherSCMEDICARE ID

Other names 1

  • Tandem Health - Family Medicine Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040603000514 SC Part B Supplier - Clinic/Group Practice 3870575855 Receives reassigned benefits from 49 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pinewood, SC; Sumter, SC
O20140204000430 SC Part A Provider - Federally Qualified Health Center (FQHC) 3870575855 Practice locations: Sumter, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356772776. Details of each certification follow.

Federally qualified health center certification: CCN 421009

Legal name
TANDEM HEALTH SC
Doing business as
TANDEM HEALTH SC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 4, 2014
Last certification
Feb 4, 2014
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Mar 31, 1999 in SC
Enrollment address
319 N Main St
Sumter, SC 29150-4258

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
42D2074002Tandem Health319 N Main Street, Sumter, SC 29150Provider-performed microscopyFeb 26, 2028

National Provider Directory

National Provider Directory
Tax ID family
Sumter Family Health Center - Administration12 organizations share this tax ID, including this one
Part of
Sumter Family Health Center - Administration

Other organizations with this tax ID 11

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

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Annie Brown Individual W-2 Managing Employee Mar 1, 2003
Operational/Managerial Control Mar 1, 2003
Ashlynd Buchanan Individual Corporate DirectorBoard of Directors Apr 1, 2026
Courtney D Butts Individual Corporate DirectorBoard of Directors Apr 1, 2026
Heidi M Adler Individual Corporate DirectorBoard of Directors Apr 8, 2021
Terrance L Dupree Individual Corporate DirectorBoard of Directors Dec 4, 2023
Linda L Jackson Individual Corporate DirectorBoard of Directors Apr 22, 2025
Melanie D Stokes-Dees Individual Corporate DirectorBoard of Directors Apr 1, 2026
Lydia J Woods-Johnson Individual Corporate DirectorBoard of Directors Apr 19, 2021
Joy Lawson Individual Corporate DirectorBoard of Directors Apr 7, 2023
Jodi L Robbins Individual Corporate OfficerBoard of Directors Apr 7, 2023
Shauna K Larson Individual Corporate DirectorBoard of Directors Apr 1, 2026
Hether H Enzor Individual Corporate DirectorBoard of Directors Apr 7, 2023
Glenn T Rivers Individual Corporate DirectorBoard of Directors Apr 1, 2026
Tracey Denise Flemming Individual Corporate DirectorBoard of Directors Apr 22, 2025
Keishan M Scott Individual Corporate DirectorBoard of Directors Apr 1, 2026

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1386720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571011200000",
    "number": "1356772776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 250",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291510250",
            "telephone_number": "803-774-4500",
            "fax_number": "803-774-4641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 N MAIN ST",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291504258",
            "telephone_number": "803-774-4500",
            "fax_number": "803-305-1466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TANDEM HEALTH SC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUMTER FAMILY HEALTH CENTER",
        "enumeration_date": "2013-12-11",
        "last_updated": "2019-10-14",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "ANNIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-774-4500"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "42-1009",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "7124",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tandem Health - Family Medicine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sumter, SC

Sources for this page

Verify at the official NPI Registry.