St James Health and Wellness Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

ST JAMES HEALTH AND WELLNESS INC

Doing business as

Andrews Elementary School Based Health Clinic

Practice address

13072 County Line Rd
Andrews, SC 29510-6811

Phone

(843) 990-7993

Fax

(843) 887-3817

NPI assigned

Jun 27, 2019

Last updated

Jun 22, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

ST. JAMES-SANTEE FAMILLY HEALTH CENTER, INC.As reported in NPPES

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

Authorized official

Name

Sandra D Gilliard

Title

Ceo

Phone

(843) 887-3274

Specialties & licenses 2

Addresses

Other names 2

• Andrews Elementary School Based Health Clinic Doing business as
• St James Santee Rural Health Program Former legal business name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629639760. Details of each certification follow.

• CCN 421066 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 421066

Legal name

ANDREWS ELEMENTARY SCHOOL BASED CLINIC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Sep 27, 2019

Last certification

Sep 27, 2019

Ownership / control type

For profit – partnership

Facility address

13072 County Line Road
Andrews, SC 29510

Part of

St James-Santee Family Heal

Locations

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

{
    "created_epoch": "1561593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655856000000",
    "number": "1629639760",
    "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": "843-887-3817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13072 COUNTY LINE RD",
            "city": "ANDREWS",
            "state": "SC",
            "postal_code": "295106811",
            "telephone_number": "843-990-7993",
            "fax_number": "843-887-3817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JAMES HEALTH AND WELLNESS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. JAMES-SANTEE FAMILLY HEALTH CENTER, INC.",
        "enumeration_date": "2019-06-27",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "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": "843-887-3274"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "ww.stjamessanteefhc.com",
            "affiliation": "N",
            "endpointDescription": "www.stjamessanteefhc.com",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "record",
            "address_1": "13072 County Line Rd",
            "city": "Andrews",
            "state": "SC",
            "country_code": "US",
            "postal_code": "295106811",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Andrews Elementary School Based Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St James Santee Rural Health Program",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "St James Santee Rural Health Program",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Chloe L Tisdale
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• Federally Qualified Health Center (FQHC) in Andrews, SC
• Providers in Andrews, SC by specialty
• Federally Qualified Health Center (FQHC) in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.