NPIMap

Individual provider Active NPI

Alan R. Sandidge, M.D.

  • Family Medicine Physician
  • Arnold, MO
National Provider Identifier
1427025295
Registry record updated Jun 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2002003294 Issued in MO
Practice address
3619 Richardson Square Dr
Suite 170
Arnold, MO 63010
Phone
(636) 717-6776
Fax
(314) 525-4055
NPI assigned
Mar 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2010

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 2002003294 MO Primary

Addresses

Primary practice location

3619 Richardson Square Dr
Suite 170
Arnold, MO 63010

Mailing address

3619 Richardson Square Dr
Suite 170
Arnold, MO 63010
Phone (636) 717-6776

Other identifiers 1

IdentifierTypeStateIssuer
205929805MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20060710000228 MO Practitioner - Family Practice 9638182843 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Saint Louis University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic East CommunitiesGroup PAC ID 7214827922, shared by 6 NPIs, 573 clinicians

Practice addresses (Care Compare)

1717 Catlin Dr
Barnhart, MO 63012-1216
Phone (636) 741-3233

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic East Communities Family Medicine CurrentSince Jan 1, 2020 Accepting new patients
Mercy Clinic East Communities Family Medicine CurrentSince Jan 1, 2020 Accepting new patients
Mercy Clinic East Communities Family Medicine Current Accepting new patients
American Multispecialty Group Inc. Family Medicine PastSince Aug 4, 2009 Accepting new patients

Locations

3619 Richardson Square Dr
Ste 170
Arnold, MO 63010
Phone (636) 717-6776

1717 Catlin Dr
Barnhart, MO 63012
Phone (636) 741-3233

179 Eureka Towne Center Dr
Eureka, MO 63025
Phone (636) 206-6725

9426 Phoenix Village Pkwy
O Fallon, MO 63368
Phone (636) 561-5707

12700 Southfork Rd
Ste 280
Saint Louis, MO 63128
Phone (314) 525-4990

5425 Southfield Ctr
Saint Louis, MO 63123
Phone (314) 543-5258

621 S New Ballas Rd
Ste 189A
Saint Louis, MO 63141
Phone (314) 251-6335

621 S New Ballas Rd
Ste 4017B
Saint Louis, MO 63141
Phone (314) 872-9192

Interoperability endpoints

  • Direct secure messaging: asandidge992535@directc.mercy.net

Organizations & group practices 4

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 6

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": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275868800000",
    "number": "1427025295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3619 RICHARDSON SQUARE DR",
            "address_2": "SUITE 170",
            "city": "ARNOLD",
            "state": "MO",
            "postal_code": "63010",
            "telephone_number": "636-717-6776",
            "fax_number": "314-525-4055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3619 RICHARDSON SQUARE DR",
            "address_2": "SUITE 170",
            "city": "ARNOLD",
            "state": "MO",
            "postal_code": "63010",
            "telephone_number": "636-717-6776",
            "fax_number": "314-525-4055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDIDGE",
        "first_name": "ALAN",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-01",
        "last_updated": "2010-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2002003294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205929805",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Arnold, MO

Sources for this page

Verify at the official NPI Registry.