NPIMap

Jim Clark Sanders, D.O.

Individual provider Active NPI Family Medicine Physician · De Soto, MO

NPI 1689608291 · NPPES record last updated Jul 26, 2010

Key facts

NPI
1689608291
Entity type
Individual (NPI type 1)
Primary specialty
Family Medicine Physician 207Q00000X
License
MD2799 (AK)
Practice address
12 Jefferson SQ
De Soto, MO 63020-1031
Phone
(636) 586-6685
Fax
(636) 586-2780
NPI assigned
Jul 10, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 1

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
HHS exclusion list flag
The National Provider Directory flags this NPI as appearing on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
MD2799AKMDFamily Medicine Physician
2009024604MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Raymond E. Andreassen Family Medicine Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD2799 AK Yes
Family Medicine Physician 207Q00000X 2009024604 MO

Addresses

Primary practice location

12 Jefferson SQ
De Soto, MO 63020-1031

Mailing address

12 Jefferson SQ
De Soto, MO 63020-1031
Phone (636) 586-6685

Other providers in De Soto, MO

All providers in De Soto, MO · Family Medicine Physician in Missouri

Sources for this page

Verify at the official NPI Registry.