Russell Leonard Sandberg, MD

Primary specialty

Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X

License

G26538 Issued in CA

Practice address

1466 Lincoln Ave
San Rafael, CA 94901-2021

Phone

(415) 457-3755

Fax

(415) 457-0849

NPI assigned

Oct 14, 2006

Last updated

Dec 1, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Marin Treatment Center

  • Methadone Clinic
  • San Rafael, CA
  • NPI 1437377421
  NPD

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

{
    "created_epoch": "1160784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322697600000",
    "number": "1265522528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "433 THE ALAMEDA",
            "city": "SAN ANSELMO",
            "state": "CA",
            "postal_code": "949601210",
            "telephone_number": "415-456-1649",
            "fax_number": "415-456-1649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1466 LINCOLN AVE",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012021",
            "telephone_number": "415-457-3755",
            "fax_number": "415-457-0849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDBERG",
        "first_name": "RUSSELL",
        "middle_name": "LEONARD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-14",
        "last_updated": "2011-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "CA",
            "license": "G26538",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G265381",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• San Rafael Smiles Dentistry, Prof. Corp (San Rafael Smiles Dentistry)
• Jessica Sananes
• Yazmin Mariana Sanchez Rodriguez
• Alissa Michelle Sanchez, P.T.
• Wendy A Sanchez, R.N.
• Katharina I Sandizell, MA, MFT
• Gaile Sands, L.M.F.T.
• Mary Ellen Sanicola
• Efrain Santamaria
• Jeremy G. Santos, RDA

• Addiction Medicine (Internal Medicine) Physician in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Addiction Medicine (Internal Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2011; 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.