Individual provider Active NPI

Sandra Marie Mills, PH.D

  • Family Psychologist
  • Fort Myers, FL
National Provider Identifier
1437439296
Registry record updated Apr 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family PsychologistTaxonomy code 103TF0000X
License
PY10873 Issued in FL
Practice address
15901 Bass Rd Ste 108
Fort Myers, FL 33908-3838
Phone
(239) 343-6050
Fax
(239) 343-6051
NPI assigned
Aug 25, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X
Family Psychologist 103TF0000X PY10873 FL Primary

Addresses

Primary practice location

15901 Bass Rd Ste 108
Fort Myers, FL 33908-3838

Mailing address

PO Box 2147
Fort Myers, FL 33902-2147
Phone (239) 343-6050

Other practice location 1

1599 J St
Grand Forks AFB, ND 58205-6306
Phone (701) 747-5560

Other identifiers 1

IdentifierTypeStateIssuer
125509300MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address smills246356@Direct.leememorial.org Lee Memorial Health System

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200911001208 FL Practitioner - Clinical Psychologist 5395998272 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lee Health System IncGroup PAC ID 9335672146, 1,381 clinicians

Practice addresses (Care Compare)

12550 New Brittany Blvd
Suite 100
Fort Myers, FL 33907-3655
Phone (239) 343-9180

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PY10873FLMDFamily Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Lee Health System Inc CurrentSince Mar 1, 2025 Accepting new patients
Lee Health System Inc CurrentSince Mar 1, 2025 Accepting new patients
Lipp, Carlson, Witucki & Associates, LTD PastSince Aug 1, 1990 Accepting new patients

Locations

1138 Country Club Blvd
Cape Coral, FL 33990
Phone (239) 424-1900

15901 Bass Rd
Ste 108
Fort Myers, FL 33908
Phone (239) 343-9890

2776 Cleveland Ave
Fort Myers, FL 33901
Phone (239) 343-2000

8931 Colonial Center Dr
Ste 401
Fort Myers, FL 33905
Phone (239) 424-2030

12550 New Brittany Blvd
Ste 100
Fort Myers, FL 33907
Phone (239) 343-9180

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: smills246356@direct.leememorial.org

Organizations & group practices 3

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": "1314230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744243200000",
    "number": "1437439296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2147",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339022147",
            "telephone_number": "239-343-6050",
            "fax_number": "239-343-6051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15901 BASS RD STE 108",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339083838",
            "telephone_number": "239-343-6050",
            "fax_number": "239-343-6051"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1599 J St",
            "address_purpose": "LOCATION",
            "city": "Grand Forks AFB",
            "state": "ND",
            "postal_code": "582056306",
            "country_code": "US",
            "telephone_number": "701-747-5560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLS",
        "first_name": "SANDRA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-25",
        "last_updated": "2025-04-10",
        "certification_date": "2025-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "FL",
            "license": "PY10873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125509300",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smills246356@Direct.leememorial.org",
            "affiliation": "Y",
            "affiliationName": "Lee Memorial Health System",
            "address_1": "2776 Cleveland Ave",
            "city": "Fort Myers",
            "state": "FL",
            "country_code": "US",
            "postal_code": "339015864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.