Sandusky Family Practice Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35-047619 Issued in OH

Legal business name

SANDUSKY FAMILY PRACTICE INC

Practice address

3103 Campbell St
Sandusky, OH 44870-7230

Phone

(419) 625-4461

Fax

(419) 625-5199

NPI assigned

Nov 10, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. James Jefferson Wysor, MDNPI 1689646481

Title

Physician

Phone

(419) 625-4461

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Richard Ralph Keller, MD

  • Family Medicine Physician
  • Sandusky, OH
  • NPI 1356314421
  Medicare reassignment NPD
• James Jefferson Wysor, MD

  • Family Medicine Physician
  • Sandusky, OH
  • NPI 1689646481
  Authorized official Same address or phone

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

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396816708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3103 CAMPBELL ST",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448707230",
            "telephone_number": "419-625-4461",
            "fax_number": "419-625-5199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3103 CAMPBELL ST",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448707230",
            "telephone_number": "419-625-4461",
            "fax_number": "419-625-5199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDUSKY FAMILY PRACTICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WYSOR",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "JEFFERSON",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "419-625-4461",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35-047619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000131843",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARAMOUNT",
            "identifier": "04375",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MED MUTUAL OF OHIO",
            "identifier": "206360201001",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0538681",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BWC",
            "identifier": "20636020100",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sandusky Artisans Cooperative
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• Sandusky City Office of Treasurer (City of Sandusky Ambulance City of Sandusky EMS)
• Sandusky City School District
• Sandusky Dialysis LLC (Sandusky Dialysis Center)
• Sandusky Gastroenterologists, Inc.
• Sandusky Lions Wrestling Club (Sandusky Lions)
• Sandusky Medical & Pain Clinic
• Sandusky Orthopedic Surgeons Inc (Sandusky Orthopedics & Rheumatology)
• Sandusky Plastic Surgery Inc (Surgery Center of Sandusky)

• Family Medicine Physician in Sandusky, OH
• Providers in Sandusky, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.