NPIMap

Organization Active NPI

Sandhills Medical Foundation, Inc.

  • Federally Qualified Health Center (FQHC)
  • Ruby, SC
National Provider Identifier
1922584481
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
290 Market Street
Ruby, SC 29741
Phone
(843) 335-8291
NPI assigned
Jul 17, 2018
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 1

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

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

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922584481. Details of each certification follow.

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
OtherNon-profit
Incorporated
May 30, 1977 in SC
Enrollment address
290 Market St
Ruby, SC 29741-2900

Other NPIs with the same Medicare PAC ID 9

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

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
42D2151677Sandhills Medical Foundation, Inc of Ruby290 Market Street, Ruby, SC 29741Certificate of waiverJul 23, 2028

National Provider Directory

National Provider Directory

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 Treasurer 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 38

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 38

NPI Registry JSON

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

{
    "created_epoch": "1531785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695945600000",
    "number": "1922584481",
    "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": "843-335-6762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 MARKET STREET",
            "city": "RUBY",
            "state": "SC",
            "postal_code": "29741",
            "telephone_number": "843-335-8291"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "645 S Seventh St",
            "address_purpose": "LOCATION",
            "city": "Mc Bee",
            "state": "SC",
            "postal_code": "291017101",
            "country_code": "US",
            "telephone_number": "843-335-8291",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SANDHILLS MEDICAL FOUNDATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-17",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ruby, SC

Sources for this page

Verify at the official NPI Registry.