Individual provider Active NPI

John E Sandgren, MD

  • Gastroenterology Physician
  • Saint Paul, MN
National Provider Identifier
1366465676
Registry record updated Feb 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
28807 Issued in MN
Practice address
2635 University Ave W
Suite 100
Saint Paul, MN 55114-1231
Phone
(651) 241-9300
Fax
(651) 241-9281
NPI assigned
Jul 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 28807 MN Primary

Addresses

Primary practice location

2635 University Ave W
Suite 100
Saint Paul, MN 55114-1231

Mailing address

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-5000

Other identifiers 1

IdentifierTypeStateIssuer
402573300MedicaidMN

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
28807MNMDGastroenterology Physician

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328140800000",
    "number": "1366465676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321",
            "telephone_number": "612-262-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2635 UNIVERSITY AVE W",
            "address_2": "SUITE 100",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141231",
            "telephone_number": "651-241-9300",
            "fax_number": "651-241-9281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDGREN",
        "first_name": "JOHN",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2012-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MN",
            "license": "28807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "402573300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 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.

Verify at the official NPI Registry.