Alexandra Blue Sanroma, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

P-T1551 Issued in AR

Practice address

500 S University Ave
Little Rock Dermatology Clinic Suite 301
Little Rock, AR 72205-5302

Phone

(501) 664-4161

Fax

(501) 664-6108

NPI assigned

Nov 9, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mrs. Alexandra Blue Gonzalez Former name

Medicare fee-for-service enrollment

Enrolled in AR

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 1

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Little Rock Dermatology Clinic P.a.Group PAC ID 4789624347, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Little Rock Dermatology Clinic P.a.

  • Dermatology Physician
  • Little Rock, AR
  • NPI 1215005731
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1447027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666224000000",
    "number": "1497128722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S UNIVERSITY AVE",
            "address_2": "LITTLE ROCK DERMATOLOGY CLINIC SUITE 301",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055302",
            "telephone_number": "501-664-4161",
            "fax_number": "501-664-6108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S UNIVERSITY AVE",
            "address_2": "LITTLE ROCK DERMATOLOGY CLINIC SUITE 301",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722055302",
            "telephone_number": "501-664-4161",
            "fax_number": "501-664-6108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANROMA",
        "first_name": "ALEXANDRA",
        "middle_name": "BLUE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-09",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AR",
            "license": "P-T1551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE",
            "identifier": "P-T1551",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALEXANDRA",
            "last_name": "GONZALEZ",
            "middle_name": "BLUE",
            "prefix": "MRS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marie Sandusky, RN, APN
• Breck Sandvall, M.D.
• Joseph Sanford Jr., M.D.
• Thomas R Sanford, M.D.
• Alexis Falon Sanghera, PROVISIONAL LMSW
• Susan M Santa Cruz, MD
• Megan Santiago, PA-C
• Melissa Santiago, PHARM.D.
• Samantha G Santiago, PA
• Kevin Andrew Santulli, PH.D.

• Medical Physician Assistant in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Medical Physician Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.