Sarah Lynette Sandoval, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209016207 Issued in IL

Practice address

509 Hamacher St Ste 103
Waterloo, IL 62298-1592

Phone

(618) 939-2273

Fax

(618) 939-0245

NPI assigned

Sep 28, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Miss Sarah Lynette Yates Former name

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Vivo Dermatology and Skin SurgeryGroup PAC ID 4183052863, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00319

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.

• Vivo Dermatology and Skin Surgery

  • Dermatology Physician
  • Saint Louis, MO
  • NPI 1043857220

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Family Practice Associates, PC

  • Family Medicine Physician
  • Waterloo, IL
  • NPI 1861688541

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1506556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567468800000",
    "number": "1093224438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 NORMA AVE",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 HAMACHER ST STE 103",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981592",
            "telephone_number": "618-939-2273",
            "fax_number": "618-939-0245"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Eleven S Ste 2E",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "IL",
            "postal_code": "622361079",
            "country_code": "US",
            "telephone_number": "618-281-2273",
            "fax_number": "618-281-0245",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3960 Lindell Blvd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631083204",
            "country_code": "US",
            "telephone_number": "314-652-0100",
            "fax_number": "314-652-0125",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDOVAL",
        "first_name": "SARAH",
        "middle_name": "LYNETTE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-28",
        "last_updated": "2019-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041427444",
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "MO",
            "license": "2012020830",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209016207",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649315219",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SARAH",
            "last_name": "YATES",
            "middle_name": "LYNETTE",
            "prefix": "MISS",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Megan Roberts
• Emma Kathryn Rogers, DC
• Stacie Roy, MHP
• Richard J Saia, DPT
• Paul Sams, RSA
• Ashley Melby Schanks, M.S.
• Lisa Schanz
• Margaret Schlotter, MHP
• Emma Schmidt, CASE MANAGER
• Madison Schmitz, RSA

• Family Nurse Practitioner in Waterloo, IL
• Providers in Waterloo, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.