Individual provider Active NPI

Bryan David Sands, DO

  • Dermatology Physician
  • Waterloo, IA
National Provider Identifier
1770548570
Registry record updated Jul 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
02896 Issued in IA
Practice address
3812 Pheasant LN
Waterloo, IA 50701-5200
Phone
(319) 236-3444
Fax
(319) 236-0257
NPI assigned
Apr 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 02896 IA Primary

Addresses

Primary practice location

3812 Pheasant LN
Waterloo, IA 50701-5200

Mailing address

3812 Pheasant LN
Waterloo, IA 50701-5200
Phone (319) 236-3444

Other identifiers 2

IdentifierTypeStateIssuer
070010603OtherIARR MDCR
0151738MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20100803001163 IA Practitioner - Dermatology 0941333561 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dermatology Associates PCGroup PAC ID 0345132049, 5 clinicians

Practice addresses (Care Compare)

3812 Pheasant LN
Waterloo, IA 50701-5200
Phone (319) 236-3444

Hospital & facility affiliations

  • Sartori Memorial Hospital, Inc Hospital, Cedar Falls, IA, CCN 160040
  • Allen Hospital Hospital, Waterloo, IA, CCN 160110
  • Mercyone Waterloo Medical Center Hospital, Waterloo, IA, CCN 160067
  • Waverly Health Center Hospital, Waverly, IA, CCN 161339

Merit-based Incentive Payment System (MIPS)

Final score
97.81 of 100Reported as group
Quality
95.62
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions197
Removal or shaving of skin growth22
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02896IAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dermatology Associates PC Dermatology CurrentSince Aug 11, 1997 Accepting new patients
Floyd County Memorial Hospital Commission Past Accepting new patients

Locations

220 Southbrooke Dr
Waterloo, IA 50702
Phone (319) 236-7720

3812 Pheasant Ln
Waterloo, IA 50701
Phone (319) 236-3444

Organizations & group practices 2

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1770548570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3812 PHEASANT LN",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507015200",
            "telephone_number": "319-236-3444",
            "fax_number": "319-236-0257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3812 PHEASANT LN",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507015200",
            "telephone_number": "319-236-3444",
            "fax_number": "319-236-0257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDS",
        "first_name": "BRYAN",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-18",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IA",
            "license": "02896",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MDCR",
            "identifier": "070010603",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0151738",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IA

Sources for this page

Verify at the official NPI Registry.