Alex Jonathan Sanderson, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

307 East Wardell Drive
Pembroke, NC 28372

Phone

(910) 521-2816

Fax

(910) 521-3583

NPI assigned

Jun 29, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1104854967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 EAST WARDELL DRIVE",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "28372",
            "telephone_number": "910-521-2816",
            "fax_number": "910-521-3583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 EAST WARDELL DRIVE",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "28372",
            "telephone_number": "910-521-2816",
            "fax_number": "910-521-3583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERSON",
        "first_name": "ALEX",
        "middle_name": "JONATHAN",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sampson Family Care Home
• Jessica Collins Sampson, D.D.S.
• Sheree L Sampson, LCMHC
• Sampson'S Family Support, LLC
• Esmeralda Sanchez
• Sandhill'S Home Care LLC
• Sandhills Home Care, LLC
• Danielle Sawyer
• Scotland Memorial Hospital
• Scotland Memorial Hospital Inc

• All providers in Pembroke, NC
• Medical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.