Kimberly Jo Sanders, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

02742 Issued in KY

Practice address

8100 Ewing Blvd
Florence, KY 41042-7588

Phone

(859) 647-8725

Fax

(859) 647-8726

NPI assigned

Apr 18, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Feb 7, 2017 through Feb 7, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Premise Health of Kentucky Medical PSC

  • Multi-Specialty Clinic/Center
  • Florence, KY
  • NPI 1649946054
  NPD (past)

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507334400000",
    "number": "1902861578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8100 EWING BLVD",
            "city": "FLORENCE",
            "state": "KY",
            "postal_code": "410427588",
            "telephone_number": "859-647-8725",
            "fax_number": "859-647-8726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8100 EWING BLVD",
            "city": "FLORENCE",
            "state": "KY",
            "postal_code": "410427588",
            "telephone_number": "859-647-8725",
            "fax_number": "859-647-8726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "KIMBERLY",
        "middle_name": "JO",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-18",
        "last_updated": "2017-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "02742",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080185147",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2212804",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64049695",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sams East Inc
• Kendell Louise Sander
• Mark D Sander, M.D.
• Admiral Dewey Sanders, PH.D.
• Deborah Ruth Sanders, CCC-SLP
• Keri Sands
• Ria Asistin Santos, M.D.
• Sarah Reilly, LLC
• Sarah Reilly, LLC
• Sarah Reilly, LLC

• Family Medicine Physician in Florence, KY
• Providers in Florence, KY by specialty
• Family Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.