Individual provider Active NPI

Karen C Sandbach, PH.D.

  • Clinical Neuropsychologist
  • Jacksonville, FL
National Provider Identifier
1083846414
Registry record updated Nov 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
PY 8871 Issued in FL
Practice address
1650 Prudential Dr Ste 210
Jacksonville, FL 32207-8149
Phone
(904) 376-3800
Fax
(904) 396-4942
NPI assigned
Aug 18, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 1224 NM
Psychologist 103T00000X 0810004652 VA
Clinical Psychologist 103TC0700X PY8871 FL
Clinical Neuropsychologist 103G00000X PY 8871 FL Primary

Addresses

Primary practice location

1650 Prudential Dr Ste 210
Jacksonville, FL 32207-8149

Mailing address

PO Box 748519
Atlanta, GA 30374-8519
Phone (904) 376-3800

Other practice location 1

3599 University Blvd S
Jacksonville, FL 32216-4252
Phone (904) 345-7607

Other names 1

  • Karen Cooper Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131205001398 FL Practitioner - Clinical Psychologist 8224265855 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
89.95 of 100Reported as group
Quality
84.69
Promoting interoperability
100
Improvement activities
40
Cost
74.91

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PY 8871FLMDClinical Neuropsychologist
0810004652VAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Behavioral Health, LLC CurrentSince Jan 10, 2018 Accepting new patients
Southern Baptist Hospital of Florida Inc Past Accepting new patients

Locations

820 Prudential Dr
Ste 510
Jacksonville, FL 32207

841 Prudential Dr
Fl 10
Jacksonville, FL 32207
Phone (904) 398-5404

1650 Prudential Dr
Ste 210
Jacksonville, FL 32207

87010 Professional Way
Yulee, FL 32097

Interoperability endpoints

  • Direct secure messaging: ksandbach24940@baptisthealthsystemjacksonville.direct-ci.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1250553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730764800000",
    "number": "1083846414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 748519",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303748519",
            "telephone_number": "904-376-3800",
            "fax_number": "904-391-5394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 PRUDENTIAL DR STE 210",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078149",
            "telephone_number": "904-376-3800",
            "fax_number": "904-396-4942"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3599 University Blvd S",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322164252",
            "country_code": "US",
            "telephone_number": "904-345-7607",
            "fax_number": "904-345-7284",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDBACH",
        "first_name": "KAREN",
        "middle_name": "C",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-18",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NM",
            "license": "1224",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "VA",
            "license": "0810004652",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY8871",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "FL",
            "license": "PY 8871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAREN",
            "last_name": "COOPER",
            "credential": "PH.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.