Active NPI
Cathy Diane Sandstrom, MD
- Pediatrics Physician
- Boise, ID
National Provider Identifier
1215926845
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- M5331
- Practice address
- 6148 N Discovery Way
Suite 100
Boise, ID 83713-0201 - Phone
- (208) 322-5437
- Fax
- (208) 322-4638
- NPI assigned
- Oct 17, 2005
- Last updated
- Nov 7, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | M5331 | ID | Primary |
Addresses
Primary practice location
6148 N Discovery Way
Suite 100
Boise, ID 83713-0201
Mailing address
6148 N Discovery Way
Suite 100
Boise, ID 83713-0201
Phone (208) 322-5437
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010005930 | Other | BLUE SHIELD | |
| 01338 | Other | BLUE CROSS OF ID | |
| 804257200 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M5331 | ID | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Pediatric and Adolescent Center, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Legal Medicine
- Boise, ID
- NPI 1144341637
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352246400000",
"number": "1215926845",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6148 N DISCOVERY WAY",
"address_2": "SUITE 100",
"city": "BOISE",
"state": "ID",
"postal_code": "837130201",
"telephone_number": "208-322-5437",
"fax_number": "208-322-4638"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6148 N DISCOVERY WAY",
"address_2": "SUITE 100",
"city": "BOISE",
"state": "ID",
"postal_code": "837130201",
"telephone_number": "208-322-5437",
"fax_number": "208-322-4638"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDSTROM",
"first_name": "CATHY",
"middle_name": "DIANE",
"name_prefix": "Mrs.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-17",
"last_updated": "2012-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "ID",
"license": "M5331",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "000010005930",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF ID",
"identifier": "01338",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "804257200",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.