NPIMap

Individual provider Active NPI

Sandford H. Kinne III, DO

  • Family Medicine Physician
  • Ormond Beach, FL
National Provider Identifier
1043328735
Registry record updated Apr 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS0006791 Issued in FL
Practice address
290 Clyde Morris Blvd
Suite a-1
Ormond Beach, FL 32174
Phone
(386) 677-5600
Fax
(386) 677-5686
NPI assigned
Aug 25, 2006
Last updated
Apr 21, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2016

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 OS0006791 FL Primary

Addresses

Primary practice location

290 Clyde Morris Blvd
Suite a-1
Ormond Beach, FL 32174

Mailing address

PO Box 731869
Ormond Beach, FL 32173-1869
Phone (386) 677-5600

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
I20090616000304 FL Practitioner - Family PracticePractitioner - Geriatric Medicine 5890845705 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
College of Osteo Med of the Pacific at Pomona, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ormond Medical ArtsGroup PAC ID 1254222565, 38 clinicians

Practice addresses (Care Compare)

77 W Granada Blvd
Ormond Beach, FL 32174-6302
Phone (904) 677-0453

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS0006791FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ormond Medical Arts Family Practice LLC Family Medicine CurrentSince Jan 1, 2019 Accepting new patients
M Medical Group SE LLC Past Accepting new patients
Pablo Garcia Jr MD Past Accepting new patients

Locations

800 N Stone St
Deland, FL 32720
Phone (386) 736-4912

77 W Granada Blvd
Ormond Beach, FL 32174
Phone (386) 677-0453

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1579/brand/8/csg/141/fhir/r4
  • Direct secure messaging: sandford.kinne.1@1579.direct.athenahealth.com
  • Direct secure messaging: sanford.kinne.1@15135.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Emory L. Bennett State Veterans' Nursing HomeDaytona Beach, FL, CCN 105840 Skilled nursing facility Adp of the SNF Mar 21, 2025
Aviata at Grand OaksPalm Coast, FL, CCN 105952 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Aug 12, 2024
Aug 12, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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 19

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

View all 19

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": "1461196800000",
    "number": "1043328735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 731869",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321731869",
            "telephone_number": "386-677-5600",
            "fax_number": "386-677-5686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 CLYDE MORRIS BLVD",
            "address_2": "SUITE A-1",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "32174",
            "telephone_number": "386-677-5600",
            "fax_number": "386-677-5686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINNE",
        "first_name": "SANDFORD",
        "middle_name": "H.",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2016-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS0006791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ormond Beach, FL

Sources for this page

Verify at the official NPI Registry.