Sandford H. Kinne III, DO
Individual provider Active NPI Family Medicine Physician · Ormond Beach, FL
NPI 1043328735 · NPPES record last updated Apr 21, 2016
Key facts
- NPI
- 1043328735
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- OS0006791 (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
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 19
Owned or controlled facilities with NPI records 2
Medicare Care Compare profile
- Specialty
- Family Practice
- 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 Arts
Practice addresses (Care Compare)
77 W Granada Blvd
Ormond Beach, FL 32174-6302
Phone (904) 677-0453
Hospital & facility affiliations
- Trilogy Home Healthcare
- Apex Home Healthcare
- Centerwell Home Health
- Halifax Health Care at Home
- Adventhealth Home Health
- Gentiva
- Halifax Health Hospice
- Vitas Healthcare Corporation of Florida
- Adventhealth Daytona Beach
- AdventHealth Palm Coast
- Adventhealth Palm Coast Parkway
- Halifax Health Medical Center
- Aviata at Grand Oaks
- Emory L Bennett Memorial Veterans Nursing Home
- Flagler Health and Rehabilitation Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Emory L. Bennett State Veterans' Nursing Home |
Skilled nursing facility | Adp of the SNF | Mar 21, 2025 |
| Aviata at Grand Oaks |
Skilled nursing facility | Operational/Managerial Control Adp of the SNF |
Aug 12, 2024 Aug 12, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090616000304 | FL | Practitioner - Family Practice |
5890845705 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS0006791 | FL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ormond Medical Arts Family Practice LLC | Family Medicine | Current |
Accepting new patients |
| Pablo Garcia Jr MD | Past | Accepting new patients | |
| M Medical Group SE LLC | Past | Accepting new patients |
Locations
800 N Stone St
Deland, FL 32720
Phone (386) 601-5220
77 W Granada Blvd
Ormond Beach, FL 32174
Phone (386) 677-0453
Interoperability endpoints
- sandford.kinne.1@1579.direct.athenahealth.com
- sanford.kinne.1@15135.direct.athenahealth.com
- https://api.platform.athenahealth.com/1579/brand/8/csg/141/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS0006791 | FL | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 013379100 | Medicaid | FL | |
| 58722 | Other | FL | AETNA |
| 593573926 | Other | FL | TRICARE HUMANA |
Other providers in Ormond Beach, FL
- Seung Hee Kim
- Cheryl Kimmel
- Isabelle B. King
- Jennifer King
- Jody Michele King
- Kist Medical LLC
- Leila Klemm
- Thomas Matthew Kline
- Andria Klioze
- Kay Louise Klymko
All providers in Ormond Beach, FL · Family Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2016. 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.
- Order and Referring (CMS).
- 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.