NPIMap

Individual provider Active NPI

Kent Michael Sandquist, PA

  • Medical Physician Assistant
  • Ontario, OR
National Provider Identifier
1407918501
Registry record updated Jan 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA01105 Issued in OR
Practice address
335 SW 13TH St
Ontario, OR 97914-4547
Phone
(541) 889-8410
Fax
(541) 889-8093
NPI assigned
Dec 14, 2006
Last updated
Jan 13, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA01105 OR Primary

Addresses

Primary practice location

335 SW 13TH St
Ontario, OR 97914-4547

Mailing address

335 SW 13TH St
Ontario, OR 97914-4547
Phone (541) 889-8410

Other identifiers 2

IdentifierTypeStateIssuer
500636562MedicaidOR
PA01105OtherORLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20060316000138 OR Practitioner - Physician Assistant 5597787531

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Malheur Memorial Health CenterGroup PAC ID 3678545993, 3 clinicians

Practice addresses (Care Compare)

410 Main St
Nyssa, OR 97913-3973
Phone (541) 372-2211

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Malheur Memorial Health Center Past Accepting new patients
Physician's Primary Care Center, Inc. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: malheurmemorial.kentsandquist@136482.advancedmd-direct.com

Organizations & group practices 2

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 12

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": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421107200000",
    "number": "1407918501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 SW 13TH ST",
            "city": "ONTARIO",
            "state": "OR",
            "postal_code": "979144547",
            "telephone_number": "541-889-8410",
            "fax_number": "541-889-8093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 SW 13TH ST",
            "city": "ONTARIO",
            "state": "OR",
            "postal_code": "979144547",
            "telephone_number": "541-889-8410",
            "fax_number": "541-889-8093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDQUIST",
        "first_name": "KENT",
        "middle_name": "MICHAEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2015-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA01105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500636562",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PA01105",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ontario, OR

Sources for this page

Verify at the official NPI Registry.