Courtni Brooke Sandras-Gaut, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904010061 Issued in VA

Practice address

402 Campbell Ave SW
Roanoke, VA 24016-3627

Phone

(540) 400-7431

Fax

(540) 400-7091

NPI assigned

Aug 15, 2017

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

Medicare fee-for-service enrollment

Enrolled in VA

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

Medicare enrollment (NPD)

Enrolled

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.

• Roanoke Resource LLC

  • Community/Behavioral Health Agency
  • Roanoke, VA
  • NPI 1104170679
  Medicare reassignment

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

{
    "created_epoch": "1502755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502755200000",
    "number": "1639695380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 541",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240030541",
            "telephone_number": "540-400-7431",
            "fax_number": "540-400-7091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 CAMPBELL AVE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240163627",
            "telephone_number": "540-400-7431",
            "fax_number": "540-400-7091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDRAS-GAUT",
        "first_name": "COURTNI",
        "middle_name": "BROOKE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-15",
        "last_updated": "2017-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904010061",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evan Parrish Sandefur, MD
• Daniel Sanders, D.C.
• Nicole Sanders, M.D.
• Sherri Lyn Sanders, PT
• Kathryn Sandifer, FNP
• Sandy M Sandridge-Moser, NP
• David Chester Sane, MD
• Maria Elizabeth Santalucia
• Richard Stephen Santiago, DO
• Taimi Santisteban Sosa, OT

• Clinical Social Worker in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.