Organization Active NPI

Foothills Family Medicine of Westminster PA

  • Preferred Provider Organization
  • Westminster, SC
National Provider Identifier
1710958210
Registry record updated Oct 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
11770 Issued in SC
Legal business name
FOOTHILLS FAMILY MEDICINE OF WESTMINSTER PA
Practice address
111 W Main St
Westminster, SC 29693-1668
Phone
(864) 647-1820
Fax
(864) 647-0403
NPI assigned
Feb 1, 2006
Last updated
Oct 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2025

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

Authorized official

Name
Shannon Dickson
Title
Billing Manager
Phone
(864) 647-1820

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X 11770 SC Primary

Addresses

Primary practice location

111 W Main St
Westminster, SC 29693-1668

Mailing address

111 W Main St
Westminster, SC 29693-1668
Phone (864) 647-1820

Other identifiers 1

IdentifierTypeStateIssuer
117705MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100217000798 SC Part B Supplier - Clinic/Group Practice 7719021542 Receives reassigned benefits from 5 practitioners
Practice locations: Westminster, SC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D0725576Foothills Family Medicine111 West Main Street, Westminster, SC 29693Provider-performed microscopyNov 16, 2026

National Provider Directory

National Provider Directory

Locations

111 W Main St
Westminster, SC 29693
Phone (803) 647-1820

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": "1138752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761696000000",
    "number": "1710958210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 W MAIN ST",
            "city": "WESTMINSTER",
            "state": "SC",
            "postal_code": "296931668",
            "telephone_number": "864-647-1820",
            "fax_number": "864-647-0403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W MAIN ST",
            "city": "WESTMINSTER",
            "state": "SC",
            "postal_code": "296931668",
            "telephone_number": "864-647-1820",
            "fax_number": "864-647-0403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOTHILLS FAMILY MEDICINE OF WESTMINSTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-01",
        "last_updated": "2025-10-29",
        "certification_date": "2025-10-29",
        "status": "A",
        "authorized_official_last_name": "DICKSON",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "864-647-1820"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "SC",
            "license": "11770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117705",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Westminster, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.