Individual provider Active NPI

Sandra G Jensen, NP

  • Nurse Practitioner
  • Southgate, MI
National Provider Identifier
1710962675
Registry record updated Feb 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704283998 Issued in MI
Practice address
15675 Northline Rd
Southgate, MI 48195-2334
Phone
(734) 282-3600
NPI assigned
Dec 13, 2005
Last updated
Feb 22, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704283998 MI Primary

Addresses

Primary practice location

15675 Northline Rd
Southgate, MI 48195-2334

Mailing address

1640 Fort St
Suite D Attn Denise
Trenton, MI 48183-2040
Phone (734) 391-3057

Other identifiers 2

IdentifierTypeStateIssuer
0H28865OtherMIBLUE CROSS
1144634403OtherGROUP NPI HENRY FORD WYANDOTTE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20110701000220 MI Practitioner - Nurse Practitioner 9739363110 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704283998MIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Wyandotte Hospital Nurse Practitioner CurrentSince Mar 1, 2021 Accepting new patients
Henry Ford Wyandotte Hospital CurrentSince Mar 1, 2021 Accepting new patients
Henry Ford Wyandotte Hospital Current Accepting new patients
Lifetime HRT, PLLC CurrentSince Feb 4, 2026 Accepting new patients

Locations

2142 Monroe St
Ste 200
Dearborn, MI 48124
Phone (313) 444-1116

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

15675 Northline Rd
Southgate, MI 48195
Phone (734) 282-3600

1640 Fort St
Ste D
Trenton, MI 48183
Phone (734) 391-3057

2070 Biddle Ave
Ste 2
Wyandotte, MI 48192
Phone (734) 284-7482

Interoperability endpoints

  • Direct secure messaging: sjensen61240@direct.hfhs.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487721600000",
    "number": "1710962675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 FORT ST",
            "address_2": "SUITE D ATTN DENISE",
            "city": "TRENTON",
            "state": "MI",
            "postal_code": "481832040",
            "telephone_number": "734-391-3057",
            "fax_number": "734-391-3052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15675 NORTHLINE RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952334",
            "telephone_number": "734-282-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "SANDRA",
        "middle_name": "G",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-13",
        "last_updated": "2017-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704283998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0H28865",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI HENRY FORD WYANDOTTE",
            "identifier": "1144634403",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southgate, MI

Sources for this page

Verify at the official NPI Registry.