NPIMap

Organization Active NPI

Sandhills Medical Foundation, Inc.

  • Federally Qualified Health Center (FQHC)
  • Jefferson, SC
National Provider Identifier
1912065467
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
409 E Church St
Jefferson, SC 29718-8701
Phone
(843) 658-3005
Fax
(843) 658-7780
NPI assigned
Dec 5, 2006
Last updated
Sep 29, 2023By the provider in NPPES
Organization subpart
No

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X SC Primary
Family Medicine Physician 207Q00000X SC

Addresses

Primary practice location

409 E Church St
Jefferson, SC 29718-8701

Mailing address

PO Box 366
MC Bee, SC 29101-0366
Phone (843) 658-3005

Other identifiers 1

IdentifierTypeStateIssuer
FQC022MedicaidSC

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
O20100831000298 SC Part A Provider - Federally Qualified Health Center (FQHC) 8224949821 Practice locations: Jefferson, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912065467. Details of each certification follow.

Federally qualified health center certification: CCN 421826

Legal name
SANDHILLS MEDICAL FOUNDATION, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 10, 1992
Last certification
Jun 10, 1992
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 30, 1977 in SC
Enrollment address
409 E Church St
Jefferson, SC 29718-8701

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

Locations

645 S Seventh St
Mc Bee, SC 29101
Phone (803) 475-4701

Ownership & related parties

All disclosed owners & managing parties 5

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
Paul Napper Individual W-2 Managing EmployeeInterim Ceo Oct 9, 2025
Operational/Managerial ControlInterim Ceo Oct 9, 2025
Lavilla Evans Individual Corporate DirectorBoard Member Jan 1, 2009
Ernest Wallace Individual Corporate DirectorBoard Member Jan 1, 2012
Amanda C Duke Individual W-2 Managing EmployeeCoo Oct 9, 2025
Operational/Managerial ControlCoo Oct 9, 2025

Practitioners & affiliated clinicians

Practitioners 27

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 27

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": "1912065467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 366",
            "city": "MC BEE",
            "state": "SC",
            "postal_code": "291010366",
            "telephone_number": "843-658-3005",
            "fax_number": "843-658-7780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 E CHURCH ST",
            "city": "JEFFERSON",
            "state": "SC",
            "postal_code": "297188701",
            "telephone_number": "843-658-3005",
            "fax_number": "843-658-7780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDHILLS MEDICAL FOUNDATION, INC.",
        "organizational_subpart": "NO",
        "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": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "SC",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FQC022",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson, SC

Sources for this page

Verify at the official NPI Registry.