Individual provider Active NPI

Sharon Anne Rooney-Gandy, DO

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Niles, MI
National Provider Identifier
1083788285
Registry record updated Jul 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianTaxonomy code 2083P0011X
License
5101011258 Issued in MI
Practice address
42 N Saint Joseph Ave Ste 103
Niles, MI 49120-2203
Phone
(269) 683-8528
Fax
(269) 683-8660
NPI assigned
Nov 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician 2083P0011X 5101011258 MI Primary

Addresses

Primary practice location

42 N Saint Joseph Ave Ste 103
Niles, MI 49120-2203

Mailing address

1000 Med Park Drive,
Suite C
Warsaw, IN 46580-3285
Phone (574) 267-8728

Other identifiers 1

IdentifierTypeStateIssuer
200950390MedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140626001031 MI Practitioner - General Surgery 7113071440 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Kansas City Medical College, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeland Medical PracticesGroup PAC ID 1658427042, 286 clinicians

Practice addresses (Care Compare)

42 N Saint Joseph Ave
Suite 103
Niles, MI 49120-2203
Phone (269) 683-8070

Hospital & facility affiliations

  • Corewell Health Lakeland Hospitals St Joseph Hospital Home health agency, Benton Harbor, MI, CCN 237163
  • Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue362
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeland Medical Practices CurrentSince Jul 12, 2018 Accepting new patients
Lakeland Medical Practices CurrentSince Jul 12, 2018 Accepting new patients

Locations

42 N Saint Joseph Ave
Niles, MI 49120
Phone (269) 684-6696

42 N Saint Joseph Ave
Ste 103
Niles, MI 49120
Phone (269) 683-8070

3950 Hollywood Rd
Ste 280
Saint Joseph, MI 49085
Phone (269) 408-0990

Interoperability endpoints

  • Direct secure messaging: srooneygandy1271672@epic00.corewelldirect.org

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563840000000",
    "number": "1083788285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 MED PARK DRIVE,",
            "address_2": "SUITE C",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465803285",
            "telephone_number": "574-267-8728",
            "fax_number": "574-269-3470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 N SAINT JOSEPH AVE STE 103",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491202203",
            "telephone_number": "269-683-8528",
            "fax_number": "269-683-8660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROONEY-GANDY",
        "first_name": "SHARON",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-20",
        "last_updated": "2019-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "MI",
            "license": "5101011258",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200950390",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Niles, MI

Sources for this page

Verify at the official NPI Registry.