NPIMap

Individual provider Active NPI

Jason Michael Sandberg, M.D.

  • Urology Physician
  • Troy, MI
National Provider Identifier
1386064939
Registry record updated Oct 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
4301501364 Issued in MI
Practice address
130 Town Center Dr Ste 101
Troy, MI 48084-1744
Phone
(248) 740-0670
Fax
(248) 740-1668
NPI assigned
Apr 22, 2014
Last updated
Oct 14, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 4301501364 MI Primary

Addresses

Primary practice location

130 Town Center Dr Ste 101
Troy, MI 48084-1744

Mailing address

20952 E 12 Mile Rd Ste 200
Saint Clair Shores, MI 48081-3203
Phone (586) 771-4820

Other practice location 1

3535 W 13 Mile Rd Ste 407
Royal Oak, MI 48073-6770
Phone (248) 551-0638

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
I20200625003163 MI Practitioner - Urology 7113248022 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Michigan Institute of Urology PCGroup PAC ID 1052223492, 82 clinicians

Practice addresses (Care Compare)

130 Town Ctr Dr
Troy, MI 48084-1744
Phone (248) 740-0670

28100 Grand River Ave
Farmington Hills, MI 48336-5970

3535 W 13 Mile Rd
Royal Oak, MI 48073-6770

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712

3601 W 13 Mile Rd Ec
Beaumont Emergency Services Ro
Royal Oak, MI 48073-6712
Phone (248) 898-5058

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
99.1 of 100Reported as individual
Promoting interoperability
97
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
84.37 of 100Reported as group
Quality
66.73
Promoting interoperability
100
Improvement activities
40
Cost
70.98

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301501364MIMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Physician Services of Michigan, P.C. Urology CurrentSince Jul 1, 2020 Accepting new patients
Beaumont Medical Group- Specialty Services CurrentSince May 1, 2021 Accepting new patients
Alliance Physician Services of Michigan, P.C. Urology CurrentSince Oct 29, 2023 Accepting new patients
Michigan Institute of Urology PC Urology CurrentSince Jul 1, 2020 Accepting new patients
William Beaumont Hospital Past Accepting new patients
William Beaumont Hospital Past Accepting new patients

Locations

28100 Grand River Ave
Ste 301
Farmington Hills, MI 48336
Phone (947) 521-1320

3535 W 13 Mile Rd
Ste 404
Royal Oak, MI 48073
Phone (248) 551-0640

3535 W 13 Mile Rd
Ste 407
Royal Oak, MI 48073
Phone (248) 551-0638

3601 W 13 Mile Rd
Royal Oak, MI 48073

3601 W 13 Mile Rd
#2S
Royal Oak, MI 48073
Phone (248) 898-0190

20952 E 12 Mile Rd
Ste 200
St Clr Shores, MI 48081
Phone (586) 771-4820

130 Town Center Dr
Ste 101
Troy, MI 48084
Phone (248) 740-0670

130 Town Center Dr
Ste 200
Troy, MI 48084
Phone (248) 740-0670

Interoperability endpoints

  • Direct secure messaging: jsandberg1254372@epic00.shdirect.org
  • Direct secure messaging: jsandberg681046@direct.hfhs.org

Organizations & group practices 6

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 7

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": "1398124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602633600000",
    "number": "1386064939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20952 E 12 MILE RD STE 200",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480813203",
            "telephone_number": "586-771-4820",
            "fax_number": "586-771-6620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 TOWN CENTER DR STE 101",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480841744",
            "telephone_number": "248-740-0670",
            "fax_number": "248-740-1668"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3535 W 13 Mile Rd Ste 407",
            "address_purpose": "LOCATION",
            "city": "Royal Oak",
            "state": "MI",
            "postal_code": "480736770",
            "country_code": "US",
            "telephone_number": "248-551-0638",
            "fax_number": "248-551-4491",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDBERG",
        "first_name": "JASON",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-22",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MI",
            "license": "4301501364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, MI

Sources for this page

Verify at the official NPI Registry.