Individual provider Active NPI

Sandra Anderson, MD

  • Pediatrics Physician
  • Oak Lawn, IL
National Provider Identifier
1669541868
Registry record updated May 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036-117093 Issued in IL
Practice address
4220 W 95TH St Ste 210
Oak Lawn, IL 60453-2793
Phone
(312) 949-4200
Fax
(708) 423-1899
NPI assigned
Nov 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036-117093 IL Primary

Addresses

Primary practice location

4220 W 95TH St Ste 210
Oak Lawn, IL 60453-2793

Mailing address

1 N Broadway St
Des Plaines, IL 60016-2335
Phone (847) 298-3150

Other identifiers 1

IdentifierTypeStateIssuer
036-117093OtherILSTATE LICENSE

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address sanderson205782@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061201000201 IL Practitioner - Pediatric Medicine 1850399700 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-117093ILMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Primecare Community Health, Inc. CurrentSince Aug 23, 2023 Accepting new patients
Endeavor Health Medical Group Pediatrics Current Accepting new patients
Access Community Health Network CurrentSince Mar 13, 2017 Accepting new patients
Access Community Health Network Current Accepting new patients
Primecare Community Health Inc CurrentSince Aug 23, 2023 Accepting new patients
Endeavor Health Medical Group CurrentSince Apr 17, 2024 Accepting new patients
Primecare Community Health, Inc. Current Accepting new patients

Locations

303 W Lake St
Ste 200
Addison, IL 60101

303 W Lake St
Addison, IL 60101
Phone (331) 221-1705

1431 N Western Ave
Ste 406
Chicago, IL 60622
Phone (312) 491-5495

9532 Eagle Way
Chicago, IL 60678

1 N Broadway St
Des Plaines, IL 60016
Phone (847) 298-3150

1200 S York St
Ste 2000
Elmhurst, IL 60126
Phone (331) 221-9002

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

Interoperability endpoints

  • Direct secure messaging: sanderson277473@direct.edward.org
  • Direct secure messaging: sanderson205782@direct.myadvocateaurora.org

Organizations & group practices 7

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": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651536000000",
    "number": "1669541868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 N BROADWAY ST",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600162335",
            "telephone_number": "847-298-3150",
            "fax_number": "847-298-5235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4220 W 95TH ST STE 210",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532793",
            "telephone_number": "312-949-4200",
            "fax_number": "708-423-1899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "SANDRA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-06",
        "last_updated": "2022-05-03",
        "certification_date": "2022-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036-117093",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036-117093",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sanderson205782@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4220 W 95th St Ste 210",
            "city": "Oak Lawn",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604532793",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "4220 W 95th St Ste 210",
            "city": "Oak Lawn",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604532793",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Oak Lawn, IL

Sources for this page

Verify at the official NPI Registry.