Individual provider Active NPI

Sandra L Santiago, MD

  • Diagnostic Radiology Physician
  • Mount Kisco, NY
National Provider Identifier
1114098555
Registry record updated Aug 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
218833 Issued in NY
Practice address
Mount Kisco Medical Group
90 South Bedford Road
Mount Kisco, NY 10549-3412
Phone
(914) 241-1050
Fax
(914) 242-2989
NPI assigned
Nov 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 218833 NY Primary

Addresses

Primary practice location

Mount Kisco Medical Group
90 South Bedford Road
Mount Kisco, NY 10549-3412

Mailing address

110 South Bedford Road
Mount Kisco Medical Group PC
Mount Kisco, NY 10549
Phone (914) 241-1050

Other identifiers 1

IdentifierTypeStateIssuer
02832048MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20070322000167 NY Practitioner - Diagnostic Radiology 8325142821 Reassigns benefits to 2 organizations
I20230630000012 NJ Practitioner - Diagnostic Radiology 8325142821 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Yale University School of Medicine, 1999
Medicare assignment
May accept Medicare assignment
Group practices
Optum Medical Care PCGroup PAC ID 9931013240, 1,013 clinicians
Optum Urgent Care PLLCGroup PAC ID 8628299518, 68 clinicians

Practice addresses (Care Compare)

15636 A Crossbay Blvd
Howard Beach, NY 11414-2745
Phone (718) 738-0700

16450 Crossbay Blvd
Howard Beach, NY 11414-3749
Phone (718) 848-8412

555 N Broadway
Jericho, NY 11753-2134
Phone (516) 597-5070

90 S Bedford Rd
Mount Kisco, NY 10549-3412
Phone (914) 241-1050

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
218833NYMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care of New Jersey PC CurrentSince Jun 1, 2023 Accepting new patients
A.G. Dikengil, MD, PA CurrentSince Jun 1, 2023 Accepting new patients
Optum Medical Care, P.C. Diagnostic Radiology CurrentSince Jan 1, 2007 Accepting new patients
Optum Medical Care, P.C. CurrentSince Jan 1, 2007 Accepting new patients
Optum Medical Care of New Jersey PC CurrentSince Jun 1, 2023 Accepting new patients
Optum Urgent Care, PLLC CurrentSince Mar 1, 2025 Accepting new patients

Locations

935 River Rd
Ste 301
Edgewater, NJ 07020
Phone (201) 471-7012

736 Page Ave
Lyndhurst, NJ 07071
Phone (201) 531-9006

1 Harmon Plz
Fl 10
Secaucus, NJ 07094
Phone (201) 636-7233

2322 30th Ave
Astoria, NY 11102
Phone (718) 267-2763

185 Route 312
Brewster, NY 10509
Phone (845) 225-2700

555 N Broadway
Jericho, NY 11753
Phone (516) 597-5070

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

110 S Bedford Rd
Mount Kisco, NY 10549
Phone (763) 910-9192

1 Pine Street Spur
Poughkeepsie, NY 12601
Phone (845) 471-2287

Philadelphia, PA 19195

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722

Interoperability endpoints

  • Direct secure messaging: ssantiago144543@direct.optum.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470355200000",
    "number": "1114098555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 SOUTH BEDFORD ROAD",
            "address_2": "MOUNT KISCO MEDICAL GROUP PC",
            "city": "MOUNT KISCO",
            "state": "NY",
            "postal_code": "10549",
            "telephone_number": "914-241-1050",
            "fax_number": "914-242-2989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MOUNT KISCO MEDICAL GROUP",
            "address_2": "90 SOUTH BEDFORD ROAD",
            "city": "MOUNT KISCO",
            "state": "NY",
            "postal_code": "105493412",
            "telephone_number": "914-241-1050",
            "fax_number": "914-242-2989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTIAGO",
        "first_name": "SANDRA",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-09",
        "last_updated": "2016-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "218833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02832048",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Kisco, NY

Sources for this page

Verify at the official NPI Registry.