NPIMap

Individual provider Active NPI

Sandra Buchanan, MD

  • Family Medicine Physician
  • Port Orange, FL
National Provider Identifier
1003923731
Registry record updated Feb 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME71541 Issued in FL
Practice address
1185 Dunlawton Ave
Suite 104
Port Orange, FL 32127-2905
Phone
(386) 767-5477
Fax
(386) 767-5580
NPI assigned
Aug 25, 2006
Last updated
Feb 10, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME71541 FL Primary

Addresses

Primary practice location

1185 Dunlawton Ave
Suite 104
Port Orange, FL 32127-2905

Mailing address

1185 Dunlawton Ave
Suite 104
Port Orange, FL 32127-2905
Phone (386) 767-5477

Other identifiers 3

IdentifierTypeStateIssuer
43582OtherFLBCBS
ME71541OtherFLSTATE MEDICAL LICENSE
255109800MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100817001501 FL Practitioner - Family Practice 8224040613 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of South Florida College of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Coastal Family Practice LLCGroup PAC ID 1850486085, 4 clinicians

Practice addresses (Care Compare)

1404 S Ridgewood Ave
Edgewater, FL 32132-2720
Phone (386) 426-8166

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions53
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Sunshine Family Healthcare, LLC Family Medicine CurrentSince Aug 1, 2002 Accepting new patients
Coastal Family Practice LLC Family Medicine CurrentSince Jan 3, 2019 Accepting new patients

Locations

1404 S Ridgewood Ave
Edgewater, FL 32132
Phone (386) 426-8166

1185 Dunlawton Ave
Ste 104
Port Orange, FL 32127
Phone (386) 767-5477

Networks

  • FL HMO
  • AL HMO D-SNP
  • devoted network organization-14bfd35d-d818-4696-813b-340339e464ef
  • FL HMO D-SNP
  • AL HMO
  • devoted network organization-25ba88d3-d0a6-4213-84f1-eef6f2b59f68
  • devoted network organization-84bf27aa-506a-49c4-8818-702cf5e8efb3
  • FL PPO
  • devoted network organization-d5084670-562f-408b-b100-22a1a4ef4d82
  • devoted network organization-0f7f8d4f-1035-4992-8c02-dc86d12e700e
  • FL HMO C-SNP

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/23575/brand/1/csg/1/fhir/r4

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391990400000",
    "number": "1003923731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1185 DUNLAWTON AVE",
            "address_2": "SUITE 104",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321272905",
            "telephone_number": "386-767-5477",
            "fax_number": "386-767-5580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1185 DUNLAWTON AVE",
            "address_2": "SUITE 104",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321272905",
            "telephone_number": "386-767-5477",
            "fax_number": "386-767-5580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCHANAN",
        "first_name": "SANDRA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-25",
        "last_updated": "2014-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME71541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "43582",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "ME71541",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "255109800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

Verify at the official NPI Registry.