Active NPI
Mark S Sandock, M.D.
- Internal Medicine Physician
- Elkhart, IN
National Provider Identifier
1225070444
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 01024361
- Practice address
- 600 East Blvd
Administration
Elkhart, IN 46514-2483 - Phone
- (574) 296-2925
- Fax
- (574) 523-3495
- NPI assigned
- Jun 12, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 01024361 | IN | Primary |
Addresses
Primary practice location
600 East Blvd
Administration
Elkhart, IN 46514-2483
Mailing address
600 East Blvd
Administration
Elkhart, IN 46514-2483
Phone (574) 296-2925
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 021236800 | Other | IN | FEDERAL BLACK LUNG |
| 100220640A | Medicaid | IN | |
| 000000215929 | Other | IN | BCBS |
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 |
|---|---|---|---|
| 01024361 | IN | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saint Joseph Regional Medical Center, Inc. | Internal Medicine | 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 and National Provider Directory roles.
-
- Pulmonary Disease Physician
- Plymouth, IN
- NPI 1225082878
Internal Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262563200000",
"number": "1225070444",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 EAST BLVD",
"address_2": "ADMINISTRATION",
"city": "ELKHART",
"state": "IN",
"postal_code": "465142483",
"telephone_number": "574-296-2925",
"fax_number": "574-523-3495"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 EAST BLVD",
"address_2": "ADMINISTRATION",
"city": "ELKHART",
"state": "IN",
"postal_code": "465142483",
"telephone_number": "574-296-2925",
"fax_number": "574-523-3495"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDOCK",
"first_name": "MARK",
"middle_name": "S",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-12",
"last_updated": "2010-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IN",
"license": "01024361",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL BLACK LUNG",
"identifier": "021236800",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100220640A",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "000000215929",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elkhart, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.