Sandhills Medical Foundation, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Ruby, SC
NPI 1922584481 · NPPES record last updated Sep 29, 2023
Key facts
- NPI
- 1922584481
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SANDHILLS MEDICAL FOUNDATION, INC.
- Practice address
- 290 Market Street
Ruby, SC 29741 - Phone
- (843) 335-8291
- NPI assigned
- Jul 17, 2018
- Organization subpart
- No
Authorized official
- Name
- Ernest James Stanley Wardlaw
- Title
- Ceo
- Phone
- (843) 335-8291
Other NPIs with the same Medicare PAC ID 9
Practitioners 37
-
Woodrow Anthony Bell, M.D.
-
Geneva Bradshaw, LPCC
-
Taylor Evans Branham, PA-C
-
Karen Elaine Clyburn, APRN
-
Lisa D Clyburn, NP-C
-
Alfred R Frye, DO
-
Allison Kazue Hamada, M.D.
-
Deidre J Hudson, MD
-
Anna Maria Lee, M.S.S.W
-
Latyce Kalynn Locker, MA, LPC, LAC, AADC
-
Morgan Lane Magee, APRN FNP
-
Angela S. Mearns, FNP
-
Kelly Michele Myers, FNP-C
-
Ayodele A Ogunfowora, M.D.
-
Akinwale Olayinka Olatosi, M.B.B.S
-
Quintella Anartica Riley, APRN
-
Nigel E. Taylor, MD
-
David E Thompson, NP
-
William Lee Wagers, D.C.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 42D2151677 | Sandhills Medical Foundation, Inc of Ruby | Certificate of waiver | Jul 23, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SC
Federally qualified health center certification: CCN 421055
- Legal name
- SANDHILLS MEDICAL FOUNDATION, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 7, 2018
- Last certification
- Sep 7, 2018
- Ownership / control type
- For profit – corporation
- Organization structure
- Other · Non-profit
- Incorporated
- May 30, 1977 in SC
- Enrollment address
- 290 Market St
Ruby, SC 29741-2900
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Janet K Defee |
Corporate Director |
Jan 1, 2009 | |
| Paul Napper |
W-2 Managing Employee |
Oct 9, 2025 | |
| Operational/Managerial Control |
Oct 9, 2025 | ||
| Lavilla Evans |
Corporate Director |
Jan 1, 2009 | |
| Ernest Wallace |
Corporate Director |
Jan 1, 2012 | |
| Amanda C Duke |
W-2 Managing Employee |
Oct 9, 2025 | |
| Operational/Managerial Control |
Oct 9, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180907000970 | SC | Part a Provider - Federally Qualified Health Center (FQHC) | 8224949821 | Practice locations: Ruby, SC |
| O20200528000475 | SC | Part B Supplier - Clinic/Group Practice | 8224949821 |
Receives reassigned benefits from 36 practitioners Practice locations: Ruby, SC |
National Provider Directory
Locations
2611 Liberty Hill Rd
Camden, SC 29020
Phone (803) 432-3447
645 S Seventh St
Mc Bee, SC 29101
Phone (803) 475-4701
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
290 Market Street
Ruby, SC 29741
Mailing address
PO Box 366
MC Bee, SC 29101-0366
Phone (843) 335-6762
Other practice location 1
645 S Seventh St
Mc Bee, SC 29101-7101
Phone (843) 335-8291
Other providers in Ruby, SC
All providers in Ruby, SC · Federally Qualified Health Center (FQHC) in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 29, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.