Individual provider Active NPI

James Sanders, MD

  • Family Medicine Physician
  • Milwaukee, WI
National Provider Identifier
1417903675
Registry record updated Aug 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
45070 Issued in WI
Practice address
1121 E North Ave
Columbia-St. Mary's Family Practice
Milwaukee, WI 53212-3515
Phone
(414) 267-6502
Fax
(414) 267-3892
NPI assigned
May 26, 2006
Last updated
Aug 11, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 45070 WI Primary

Addresses

Primary practice location

1121 E North Ave
Columbia-St. Mary's Family Practice
Milwaukee, WI 53212-3515

Mailing address

1121 E North Ave
Columbia-St. Mary's Family Practice
Milwaukee, WI 53212-3515
Phone (414) 267-6502

Other identifiers 3

IdentifierTypeStateIssuer
31978600MedicaidWI
008000261POtherHUMANA
1417903675MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100706000208 WI Practitioner - Family Practice 5395876411 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
45070WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Medical College of Wisconsin, Inc. Family Medicine CurrentSince Nov 1, 2002 Accepting new patients

Locations

1121 E North Ave
Milwaukee, WI 53212
Phone (414) 267-6500

Bin 88350
Milwaukee, WI 53288
Phone (414) 805-3122

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

9000 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 266-2625

Interoperability endpoints

  • Direct secure messaging: jsanders756537@direct.ochin.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313020800000",
    "number": "1417903675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 E NORTH AVE",
            "address_2": "COLUMBIA-ST. MARY'S FAMILY PRACTICE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532123515",
            "telephone_number": "414-267-6502",
            "fax_number": "414-267-3892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 E NORTH AVE",
            "address_2": "COLUMBIA-ST. MARY'S FAMILY PRACTICE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532123515",
            "telephone_number": "414-267-6502",
            "fax_number": "414-267-3892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-26",
        "last_updated": "2011-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "45070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31978600",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "008000261P",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417903675",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.