NPIMap

Individual provider Active NPI

Carrie S Sandborn, D.O.

  • Family Medicine Physician
  • East Lansing, MI
National Provider Identifier
1356540116
Registry record updated Sep 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101017259 Issued in MI
Practice address
804 Service Rd Ste A142
East Lansing, MI 48824-7015
Phone
(517) 353-3050
Fax
(517) 432-3742
NPI assigned
Jul 12, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5101017259 MI Primary

Addresses

Primary practice location

804 Service Rd Ste A142
East Lansing, MI 48824-7015

Mailing address

804 Service Rd
# A109F
East Lansing, MI 48824-7015

Other names 1

  • Carrie S Shearer Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090408000051 MI Practitioner - Family Practice 4880741941 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Western Michigan UniversityGroup PAC ID 8426017179, 11 clinicians

Practice addresses (Care Compare)

1903 W Michigan Ave
Wmu Sindecuse Health Center
Kalamazoo, MI 49008-5200
Phone (269) 387-3290

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101017259MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Edward W. Sparrow Hospital Association Family Medicine CurrentSince Sep 1, 2018 Accepting new patients
Edward W. Sparrow Hospital Association Current Accepting new patients
Edward W Sparrow Hospital Association Family Medicine CurrentSince Sep 1, 2018 Accepting new patients
Western Michigan University CurrentSince Aug 20, 2022 Accepting new patients
Whitehall SNF, LLC Past Accepting new patients
Westwood Opco, LLC Past Accepting new patients
Mercy Urgent Care Family Medicine Past Accepting new patients
Michigan State University Past Accepting new patients
Michigan State University Kalamazoo Center for Medical Studies Past Accepting new patients
Pennock Hospital Family Medicine Past Accepting new patients
Knollview SNF, LLC Past Accepting new patients

Locations

8175 Reliable Pkwy
Chicago, IL 60686

1903 W Michigan Ave
Kalamazoo, MI 49008
Phone (269) 387-3248

1000 Oakland Dr
Kalamazoo, MI 49008
Phone (269) 337-4347

800 E Columbia St
Mason, MI 48854
Phone (517) 244-8900

1600 W Grand River Ave
Ste 2
Okemos, MI 48864
Phone (517) 349-6560

Organizations & group practices 11

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": "1184198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537833600000",
    "number": "1356540116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 SERVICE RD",
            "address_2": "# A109F",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 SERVICE RD STE A142",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488247015",
            "telephone_number": "517-353-3050",
            "fax_number": "517-432-3742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDBORN",
        "first_name": "CARRIE",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-12",
        "last_updated": "2018-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101017259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARRIE",
            "last_name": "SHEARER",
            "middle_name": "S",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in East Lansing, MI

Sources for this page

Verify at the official NPI Registry.