NPIMap

Organization Active NPI

Tandem Health SC

  • Federally Qualified Health Center (FQHC)
  • Sumter, SC
National Provider Identifier
1386630192
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
1278 N Lafayette Dr
Sumter, SC 29150-2964
Phone
(803) 774-4500
Fax
(803) 774-4627
NPI assigned
Sep 27, 2005
Last updated
Oct 14, 2019By the provider in NPPES
Organization subpart
No

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
Ms. Annie B Brown
Title
Ceo
Phone
(803) 774-4500

Specialties & licenses 1

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

Addresses

Primary practice location

1278 N Lafayette Dr
Sumter, SC 29150-2964

Mailing address

1278 N Lafayette Dr
Sumter, SC 29150-2964
Phone (803) 774-4500

Other identifiers 1

IdentifierTypeStateIssuer
FQC048MedicaidSC

Other names 1

  • Sumter Family Health Center Former legal business 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
Practice locations: Pinewood, SC; Sumter, SC
O20101130000215 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 1386630192. Details of each certification follow.

Federally qualified health center certification: CCN 421866

Legal name
TANDEM HEALTH SC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 16, 2001
Last certification
Apr 16, 2001
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jul 13, 2005 in SC
Enrollment address
1278 N Lafayette Dr
Sumter, SC 29150-2964

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.

National Provider Directory

National Provider Directory

Locations

1278 N Layfayette St
Sumter, SC 29150

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 Corporate OfficerCeo Mar 1, 2003
W-2 Managing Employee 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 DirectorBoard 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 49

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 49

NPI Registry JSON

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571011200000",
    "number": "1386630192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1278 N LAFAYETTE DR",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291502964",
            "telephone_number": "803-774-4500",
            "fax_number": "803-774-4650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1278 N LAFAYETTE DR",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291502964",
            "telephone_number": "803-774-4500",
            "fax_number": "803-774-4627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TANDEM HEALTH SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-27",
        "last_updated": "2019-10-14",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "ANNIE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-774-4500",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC048",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sumter Family Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Sumter, SC

Sources for this page

Verify at the official NPI Registry.