NPIMap

Organization Active NPI

St James Health and Wellness Inc

Doing business as St James Santee Family Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Georgetown, SC
National Provider Identifier
1366568594
Registry record updated Jun 22, 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
St James Santee Family Health Center Inc
Practice address
422 N Fraser St
Georgetown, SC 29440-3260
Phone
(843) 436-1333
Fax
(843) 436-1335
NPI assigned
Mar 21, 2007
Last updated
Jun 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2022

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

Authorized official

Name
Mrs. Sandra Gilliard
Title
Ceo
Phone
(843) 887-3274

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Pediatric Adolescent Medicine Physician 2080A0000X 37759 SC

Addresses

Primary practice location

422 N Fraser St
Georgetown, SC 29440-3260

Mailing address

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

Other practice location 1

57 Jessamine Ave
Georgetown, SC 29440-5837
Phone (843) 546-8686

Other identifiers 1

IdentifierTypeStateIssuer
377596MedicaidSC

Other names 1

  • St James Santee Family Health Center Inc Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050810000151 SC Part B Supplier - Clinic/Group Practice 1658280334 Receives reassigned benefits from 22 practitioners
4 other NPIs on this enrollment
Practice locations: Georgetown, SC; McClellanville, SC
O20071105000343 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 1366568594. Details of each certification follow.

Federally qualified health center certification: CCN 421900

Legal name
ST JAMES HEALTH AND WELLNESS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 12, 2007
Last certification
Nov 12, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1981 in SC
Enrollment address
422 N Fraser St
Georgetown, SC 29440-3260

Other NPIs with the same Medicare PAC ID 6

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.

National Provider Directory

National Provider Directory

Locations

57 Jessamine Ave
Georgetown, SC 29440
Phone (843) 546-8686

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
Sandra D. Gilliard Individual Corporate DirectorCeo Oct 4, 2007 100%
W-2 Managing EmployeeCeo Jul 2, 2011 100%
Gilmore McManus Individual Corporate OfficerBoard Member Mar 31, 2014 100%
Corporate DirectorBoard Member Mar 31, 2014 100%
Joyce Cox Holmes Individual Corporate OfficerBoard Member Mar 8, 2013 100%
Hessie Richard Individual Corporate OfficerBoard Member Jul 21, 2015 100%
Earnestine Williams Individual Corporate OfficerBoard Member Mar 28, 2017 100%

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655856000000",
    "number": "1366568594",
    "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": "843-887-3929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "422 N FRASER ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294403260",
            "telephone_number": "843-436-1333",
            "fax_number": "843-436-1335"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "57 Jessamine Ave",
            "address_purpose": "LOCATION",
            "city": "Georgetown",
            "state": "SC",
            "postal_code": "294405837",
            "country_code": "US",
            "telephone_number": "843-546-8686",
            "fax_number": "843-546-1353",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST JAMES HEALTH AND WELLNESS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A",
        "authorized_official_last_name": "GILLIARD",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-887-3274",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "SC",
            "license": "37759",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "377596",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St James Santee Family Health Center Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St James Santee Family Health Center Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Georgetown, SC

Sources for this page

Verify at the official NPI Registry.