Sanders Medical Group, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

SANDERS MEDICAL GROUP, PLLC

Practice address

170 Medical Park Rd Ste 203
Mooresville, NC 28117-8540

Phone

(980) 550-2400

Fax

(950) 550-2424

NPI assigned

Dec 23, 2021

Organization subpart

No

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

Authorized official

Name

Blake Sanders, DONPI 1972962710

Title

Founder & Medical Director

Phone

(980) 550-2400

Specialties & licenses 1

Addresses

Other names 1

• Sacred Heart Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Blake Sanders, DO

  • Dermatology Physician
  • Mooresville, NC
  • NPI 1972962710
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1640217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640822400000",
    "number": "1609536267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 MEDICAL PARK RD STE 203",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178540",
            "telephone_number": "980-550-2400",
            "fax_number": "950-550-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 MEDICAL PARK RD STE 203",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178540",
            "telephone_number": "980-550-2400",
            "fax_number": "950-550-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDERS MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-23",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-30",
        "status": "A",
        "authorized_official_last_name": "SANDERS",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_title_or_position": "FOUNDER & MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "980-550-2400",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sacred Heart Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sacred Heart Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alexander Francis Sanchez Jr., M.D.
• Rosalina Gabrielle Sanchez
• Terri Lynn Sanchez
• Todd Anthony Sandagato, PA
• Taylor White Sandberg, MD
• Blake Sanders, DO
• Skyler Sanders, PHARMD
• Michelle Sandiford
• Kasie Sands, LCMHCA
• Sannas-24

• Dermatology Physician in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Dermatology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.