Active NPI
Emily Burgess Sandfort, PA-C
- Physician Assistant
- Green Bay, WI
National Provider Identifier
1770835415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA173023
- Practice address
- 835 S Van Buren St
Green Bay, WI 54301-3526 - Phone
- (414) 294-8828
- NPI assigned
- Oct 4, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA173023 | OR | Primary |
| Physician Assistant | 363A00000X | MA055740 | PA | |
| Surgical Physician Assistant | 363AS0400X | 3100-23 | WI |
Addresses
Primary practice location
835 S Van Buren St
Green Bay, WI 54301-3526
Mailing address
376 Chase Ave
De Pere, WI 54115-4071
Phone (414) 294-8288
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | esandfort75111@ewd.direct.hshs.org | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Interoperability endpoints
- esandfor@yourcarecommunity.org
- esandfort75111@ewd.direct.hshs.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640649600000",
"number": "1770835415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "376 CHASE AVE",
"city": "DE PERE",
"state": "WI",
"postal_code": "541154071",
"telephone_number": "414-294-8288"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "835 S VAN BUREN ST",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543013526",
"telephone_number": "414-294-8828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDFORT",
"first_name": "EMILY",
"middle_name": "BURGESS",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-04",
"last_updated": "2021-12-28",
"certification_date": "2021-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OR",
"license": "PA173023",
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "MA055740",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "WI",
"license": "3100-23",
"primary": false
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "esandfort75111@ewd.direct.hshs.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CDA/CCD/TXT",
"address_1": "835 S Van Buren St",
"city": "Green Bay",
"state": "WI",
"country_code": "US",
"postal_code": "543013526",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.