NPIMap

Organization Active NPI

Sandhills Medical Foundation, Inc.

  • Federally Qualified Health Center (FQHC)
  • Lugoff, SC
National Provider Identifier
1487712923
Registry record updated Sep 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SANDHILLS MEDICAL FOUNDATION, INC.
Practice address
40 Baldwin Ave.
Lugoff, SC 29078-8966
Phone
(803) 408-3262
Fax
(803) 408-8895
NPI assigned
Dec 5, 2006
Last updated
Sep 29, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SANDHILLS MEDICAL FOUNDATION, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 29, 2023

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

Authorized official

Name
Ernest James Stanley WardlawNPI 1508276528
Title
Ceo
Phone
(843) 335-8291

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X SC
Federally Qualified Health Center (FQHC) 261QF0400X SC Primary

Addresses

Primary practice location

40 Baldwin Ave.
Lugoff, SC 29078-8966

Mailing address

PO Box 366
McBee, SC 29101-7101
Phone (843) 335-8291

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031126000326 SC Part B Supplier - Clinic/Group Practice 8224949821 Receives reassigned benefits from 39 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Camden, SC; Jefferson, SC; Kershaw, SC; Lugoff, SC; MC Bee, SC; Sumter, SC
O20080815000122 SC Part A Provider - Federally Qualified Health Center (FQHC) 8224949821 Practice locations: Lugoff, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487712923. Details of each certification follow.

Federally qualified health center certification: CCN 421902

Legal name
SANDHILLS MEDICAL FOUNDATION, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 3, 2008
Last certification
Sep 3, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 30, 1977 in SC
Enrollment address
40 Baldwin Ave
Lugoff, SC 29078-9406

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 6

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

National Provider Directory

National Provider Directory
Part of
Sandhills Med Foundat I

Locations

103 Main St N
Bethune, SC 29009
Phone (843) 334-6551

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Janet K Defee Individual Corporate DirectorBoard Member Jan 1, 2009
Michele Reeder Individual Corporate DirectorBoard Member Jan 2, 2011
Paul Napper Individual Corporate DirectorInterim Ceo Oct 9, 2025
W-2 Managing EmployeeInterim Ceo Oct 9, 2025
Operational/Managerial ControlInterim Ceo Oct 9, 2025
Lavilla Evans Individual Corporate DirectorBoard Member Jan 2, 2009
Ernest Wallace Individual Corporate DirectorVice Chair Board Member Jan 2, 2009
Amanda C Duke Individual W-2 Managing EmployeeCoo Oct 9, 2025
Operational/Managerial ControlCoo Oct 9, 2025

Practitioners & affiliated clinicians

Practitioners 47

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 47

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695945600000",
    "number": "1487712923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 366",
            "city": "MCBEE",
            "state": "SC",
            "postal_code": "291017101",
            "telephone_number": "843-335-8291",
            "fax_number": "843-335-8731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 BALDWIN AVE.",
            "city": "LUGOFF",
            "state": "SC",
            "postal_code": "290788966",
            "telephone_number": "803-408-3262",
            "fax_number": "803-408-8895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDHILLS MEDICAL FOUNDATION, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SANDHILLS MEDICAL FOUNDATION, INC.",
        "enumeration_date": "2006-12-05",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A",
        "authorized_official_last_name": "WARDLAW",
        "authorized_official_first_name": "ERNEST",
        "authorized_official_middle_name": "JAMES STANLEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "843-335-8291"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "SC",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lugoff, SC

Sources for this page

Verify at the official NPI Registry.