Individual provider Active NPI

Jessica Ann Sander, PA-C

  • Physician Assistant
  • Tallahassee, FL
National Provider Identifier
1477178275
Registry record updated Sep 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9113150 Issued in FL
Practice address
1704 Riggins Rd
Tallahassee, FL 32308-5318
Phone
(850) 877-4134
NPI assigned
Jun 8, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9113150 FL Primary

Addresses

Primary practice location

1704 Riggins Rd
Tallahassee, FL 32308-5318

Mailing address

PO Box 13834
Tallahassee, FL 32317-3834

Other practice location 1

248 NE Hancock Ave
Madison, FL 32340-2560
Phone (850) 877-4134

Other practice location 2

1516 E Evans St
Bainbridge, GA 39819-4363
Phone (229) 792-8119

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, GA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200730002710 FL Practitioner - Physician Assistant 3274958764 Reassigns benefits to 1 organization
I20200918001924 GA Practitioner - Physician Assistant 3274958764 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1707 Riggins Rd
Tallahassee, FL 32308-5317
Phone (850) 877-4134

2401 Osler CT
Albany, GA 31707-0205
Phone (229) 792-8119

248 NE Hancock Ave
Madison, FL 32340-2560
Phone (850) 877-4134

Merit-based Incentive Payment System (MIPS)

Final score
89.59 of 100Reported as group
Quality
100
Promoting interoperability
91
Improvement activities
40
Cost
72.81

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Dermatology Associates of Tallahassee, PA CurrentSince Jun 16, 2020 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

248 NE Hancock Ave
Madison, FL 32340
Phone (850) 973-2252

1707 Riggins Rd
Tallahassee, FL 32308
Phone (850) 205-6232

2401 Osler Ct
Albany, GA 31707
Phone (229) 469-4383

1516 E Evans St
Bainbridge, GA 39819
Phone (229) 246-4888

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": "1591574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600041600000",
    "number": "1477178275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13834",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323173834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704 RIGGINS RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323085318",
            "telephone_number": "850-877-4134"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "248 NE Hancock Ave",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "FL",
            "postal_code": "323402560",
            "country_code": "US",
            "telephone_number": "850-877-4134",
            "fax_number": "850-402-9130",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1516 E Evans St",
            "address_purpose": "LOCATION",
            "city": "Bainbridge",
            "state": "GA",
            "postal_code": "398194363",
            "country_code": "US",
            "telephone_number": "229-792-8119",
            "fax_number": "850-402-9130",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDER",
        "first_name": "JESSICA",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-08",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9113150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

Verify at the official NPI Registry.