NPIMap

Individual provider Active NPI

Layne C. Sandridge, M.D.

  • Vascular Surgery Physician
  • Glendale, AZ
National Provider Identifier
1063689909
Registry record updated Jan 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
40861 Issued in AZ
Practice address
18700 N 64TH Dr Ste 105a
Glendale, AZ 85308-7110
Phone
(623) 688-5075
Fax
(623) 688-5075
NPI assigned
May 9, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 4, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 40861 AZ Primary

Addresses

Primary practice location

18700 N 64TH Dr Ste 105a
Glendale, AZ 85308-7110

Mailing address

19801 N 59TH Ave Unit 11659
Glendale, AZ 85318-5068
Phone (623) 688-5075

Other identifiers 2

IdentifierTypeStateIssuer
398159MedicaidAZ
Z216660OtherAZMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20090202000525 AZ Practitioner - Vascular SurgeryPractitioner - General Surgery 5395809511 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular SurgeryAlso: General Surgery
Education
Louisiana State University School of Medicine in New Orleans, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
District Medical Group IncGroup PAC ID 7315086691, 454 clinicians

Practice addresses (Care Compare)

2601 E Roosevelt St
Phoenix, AZ 85008-4973
Phone (602) 344-5011

3141 N 3Rd Ave
Phoenix, AZ 85013-4360
Phone (602) 914-1520

Hospital & facility affiliations

  • Valleywise Health Medical Center Hospital, Phoenix, AZ, CCN 030022

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
District Medical Group, Inc Current Accepting new patients
Pulse Cardiovascular Institute LLC Vascular Surgery CurrentSince Nov 13, 2019 Accepting new patients
L Philipp Wall MD PC Vascular Surgery Past Accepting new patients
District Medical Group, Inc Surgery Past Accepting new patients
Pulse Cardiovascular Interventions LLC PastSince Dec 1, 2023 Accepting new patients
Lpwallmd PC Vascular Surgery PastSince Dec 15, 2024 Accepting new patients

Locations

2601 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 220-0298

3141 N 3rd Ave
Phoenix, AZ 85013
Phone (602) 914-1520

2525 E Roosevelt St
Phoenix, AZ 85008
Phone (602) 344-1015

7281 E Earll Dr
Ste A
Scottsdale, AZ 85251
Phone (480) 584-3007

7285 E Earll Dr
Bldg C
Scottsdale, AZ 85251
Phone (480) 600-0600

Interoperability endpoints

  • Direct secure messaging: laynesandridge@cvc.allscriptsdirect.net
  • Direct secure messaging: lsandridge126016@direct.valleywisehealth.org

Organizations & group practices 6

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

Hospital & facility affiliations 12

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": "1210291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546560000000",
    "number": "1063689909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19801 N 59TH AVE UNIT 11659",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853185068",
            "telephone_number": "623-688-5075",
            "fax_number": "623-688-5075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18700 N 64TH DR STE 105A",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853087110",
            "telephone_number": "623-688-5075",
            "fax_number": "623-688-5075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDRIDGE",
        "first_name": "LAYNE",
        "middle_name": "C.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-09",
        "last_updated": "2019-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "AZ",
            "license": "40861",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "398159",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "Z216660",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.