Active NPI
Sandra Denise Jackson
- Home Health Agency
- Sumter, SC
National Provider Identifier
1932846649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- LI-234264
- Practice address
- 1150 Broad St Ste 4
Sumter, SC 29150-1997 - Phone
- (803) 869-1005
- NPI assigned
- May 14, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | LI-234264 | SC | Primary |
Addresses
Primary practice location
1150 Broad St Ste 4
Sumter, SC 29150-1997
Mailing address
1150 Broad St
Sumter, SC 29150-1997
Phone (803) 566-3921
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LI-234264 | SC | MD | Home Health Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652486400000",
"number": "1932846649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1150 BROAD ST",
"city": "SUMTER",
"state": "SC",
"postal_code": "291501997",
"telephone_number": "803-566-3921"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1150 BROAD ST STE 4",
"city": "SUMTER",
"state": "SC",
"postal_code": "291501997",
"telephone_number": "803-869-1005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SANDRA",
"middle_name": "DENISE",
"name_prefix": "Miss",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-05-14",
"last_updated": "2022-05-14",
"certification_date": "2022-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "SC",
"license": "LI-234264",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sumter, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.