Active NPI
David Sandifer
- Nurse Practitioner
- Fort Wayne, IN
National Provider Identifier
1386308922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 28223639A
- Practice address
- 5015 W Jefferson Blvd
Fort Wayne, IN 46804-6803 - Phone
- (219) 508-6424
- NPI assigned
- Oct 29, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 28223639A | IN | Primary |
Addresses
Primary practice location
5015 W Jefferson Blvd
Fort Wayne, IN 46804-6803
Mailing address
3144 Breyerton CV
Fort Wayne, IN 46814-0002
Phone (219) 508-6424
Other practice location 1
700 Broadway
Fort Wayne, IN 46802-1493
Phone (260) 425-3000
Other practice location 2
3144 Breyerton Cv
Fort Wayne, IN 46814-0002
Phone (219) 508-6424
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28223639A | IN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Femme Med & Spa | Nurse Practitioner | Current | Accepting new patients |
Locations
5015 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (219) 508-6424
Organizations & group practices 1
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": "1635465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740528000000",
"number": "1386308922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3144 BREYERTON CV",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468140002",
"telephone_number": "219-508-6424"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5015 W JEFFERSON BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468046803",
"telephone_number": "219-508-6424"
}
],
"practiceLocations": [
{
"address_1": "700 Broadway",
"address_purpose": "LOCATION",
"city": "Fort Wayne",
"state": "IN",
"postal_code": "468021493",
"country_code": "US",
"telephone_number": "260-425-3000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3144 Breyerton Cv",
"address_purpose": "LOCATION",
"city": "Fort Wayne",
"state": "IN",
"postal_code": "468140002",
"country_code": "US",
"telephone_number": "219-508-6424",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SANDIFER",
"first_name": "DAVID",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-10-29",
"last_updated": "2025-02-26",
"certification_date": "2025-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IN",
"license": "28223639A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2025; 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.