Individual provider Active NPI

Jessica Marie Sanford, FNP

  • Family Medicine Physician
  • Dallas, TX
National Provider Identifier
1295456184
Registry record updated Oct 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A170959 Issued in IA
Practice address
4055 Valley View LN
Dallas, TX 75244-5074
Phone
(855) 984-5121
NPI assigned
Sep 8, 2022
Last updated
Oct 19, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X A170959 IA
Family Medicine Physician 207Q00000X A170959 IA Primary
General Practice Physician 208D00000X A170959 IA

Addresses

Primary practice location

4055 Valley View LN
Dallas, TX 75244-5074

Mailing address

63 SE Dorr Dr Apt Suite
Pleasant Hill, IA 50327-8564
Phone (515) 554-4787

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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

Enrollment IDStateProvider typePAC IDDetails
I20221229000271 IA Practitioner - Nurse Practitioner 4183094568 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

8131 University Blvd
Clive, IA 50325-1123
Phone (515) 965-3405

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
A170959IAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Soderstrom Dermatology Center S C CurrentSince Feb 1, 2023 Accepting new patients
Soderstrom Dermatology Center S C CurrentSince Feb 1, 2023 Accepting new patients
Signify Health Medical Associates, PLLC General Practice CurrentSince Sep 20, 2023 Accepting new patients
Fawad S. Zafar MD PC PastSince Dec 1, 2022 Accepting new patients

Locations

1800 E 54th St
Ste B
Davenport, IA 52807
Phone (563) 242-3571

400 E Court Ave
Ste 110
Des Moines, IA 50309

8131 University Blvd
Des Moines, IA 50325
Phone (515) 225-8180

4909 N Glen Park Place Rd
Peoria, IL 61614
Phone (309) 674-7546

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Organizations & group practices 4

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1662595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666137600000",
    "number": "1295456184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 SE DORR DR APT SUITE",
            "city": "PLEASANT HILL",
            "state": "IA",
            "postal_code": "503278564",
            "telephone_number": "515-554-4787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 VALLEY VIEW LN",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752445074",
            "telephone_number": "855-984-5121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANFORD",
        "first_name": "JESSICA",
        "middle_name": "MARIE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-08",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IA",
            "license": "A170959",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "A170959",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IA",
            "license": "A170959",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.