NPIMap

Organization Active NPI

Tandem Health SC

  • Federally Qualified Health Center (FQHC)
  • Pinewood, SC
National Provider Identifier
1689447534
Registry record updated Dec 11, 2024
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
200 W. Clark St.
Pinewood, SC 29125-9998
Phone
(803) 830-6184
Fax
(803) 774-4626
NPI assigned
Nov 2, 2023
Last updated
Dec 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2024

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

Authorized official

Name
Ms. Annie Brown
Title
Ceo
Phone
(803) 774-4545

Specialties & licenses 1

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

Addresses

Primary practice location

200 W. Clark St.
Pinewood, SC 29125-9998

Mailing address

550 S. Pike West
Sumter, SC 29150-2616
Phone (803) 324-6975

Other identifiers 1

IdentifierTypeStateIssuer
FQC309MedicaidSC

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20241119001898 SC Part A Provider - Federally Qualified Health Center (FQHC) 3870575855 Practice locations: Pinewood, SC
O20250107001306 SC Part B Supplier - Clinic/Group Practice 3870575855 Receives reassigned benefits from 6 practitioners
Practice locations: Pinewood, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689447534. Details of each certification follow.

Federally qualified health center certification: CCN 421106

Legal name
TANDEM HEALTH SC
Doing business as
TANDEM HEALTH SC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 9, 2024
Last certification
Aug 9, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 30, 1999 in SC
Enrollment address
200 W Clark St
Pinewood, SC 29125-9598

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

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

Other organizations with this tax ID 11

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

Locations

200 W Clark St
Pinewood, SC 29125
Phone (803) 830-6184

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 30, 1999
W-2 Managing EmployeeCeo Mar 30, 1999
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 OfficerBoard 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 6

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": "1698883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733875200000",
    "number": "1689447534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 S. PIKE WEST",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291502616",
            "telephone_number": "803-324-6975",
            "fax_number": "803-324-6975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W. CLARK ST.",
            "city": "PINEWOOD",
            "state": "SC",
            "postal_code": "291259998",
            "telephone_number": "803-830-6184",
            "fax_number": "803-774-4626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TANDEM HEALTH SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-02",
        "last_updated": "2024-12-11",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "ANNIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-774-4545",
        "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": "FQC309",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pinewood, SC

Sources for this page

Verify at the official NPI Registry.