NPIMap

Individual provider Active NPI

David Roberts Sanders, PA-C

  • Physician Assistant
  • Vinton, VA
National Provider Identifier
1104163856
Registry record updated Sep 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110011925 Issued in VA
Practice address
415 S Pollard St
Vinton, VA 24179-2502
Phone
(540) 983-6700
Fax
(540) 982-6928
NPI assigned
Jan 14, 2013
Last updated
Sep 15, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-04018 NC
Physician Assistant 363A00000X 0110011925 VA Primary
Medical Physician Assistant 363AM0700X 0010-04018 NC
Emergency Medicine Physician 207P00000X 0010-04018 NC

Addresses

Primary practice location

415 S Pollard St
Vinton, VA 24179-2502

Mailing address

213 S Jefferson St Ste 1006
Roanoke, VA 24011-1713
Phone (540) 224-5516

Other practice location 1

1570 Nc 8 and 89 Hwy N
Danbury, NC 27016-7360
Phone (336) 593-2831

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20130224000012 NC Practitioner - Physician Assistant 4981859907 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1570 NC 8 and 89 Hwy N
Danbury, NC 27016-7360
Phone (336) 593-2831

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-04018NCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lifebrite Hospital Group of Stokes, LLC CurrentSince Jan 31, 2017 Accepting new patients
Lifebrite Hospital Group of Stokes, LLC CurrentSince Jan 31, 2017 Accepting new patients
Lifebrite Hospital Group of Stokes, LLC Past Accepting new patients
Bethany Medical Center Physician Assistant Past Accepting new patients

Locations

1030 Hospice Dr
Danbury, NC 27016
Phone (336) 593-5354

1570 NC 8 and 89 Hwy N
Danbury, NC 27016
Phone (336) 593-2831

402 W King St
King, NC 27021
Phone (336) 529-4304

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1358121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789430400000",
    "number": "1104163856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 S JEFFERSON ST STE 1006",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240111713",
            "telephone_number": "540-224-5516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 S POLLARD ST",
            "city": "VINTON",
            "state": "VA",
            "postal_code": "241792502",
            "telephone_number": "540-983-6700",
            "fax_number": "540-982-6928"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1570 Nc 8 and 89 Hwy N",
            "address_purpose": "LOCATION",
            "city": "Danbury",
            "state": "NC",
            "postal_code": "270167360",
            "country_code": "US",
            "telephone_number": "336-593-2831",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "DAVID",
        "middle_name": "ROBERTS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-01-14",
        "last_updated": "2026-09-15",
        "certification_date": "2026-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-04018",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110011925",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-04018",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "0010-04018",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vinton, VA

Sources for this page

Verify at the official NPI Registry.