NPIMap

Organization Active NPI

Sandford H Kinne III D O P a

  • Family Medicine Physician
  • Ormond Beach, FL
National Provider Identifier
1942435920
Registry record updated May 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS0006791 Issued in FL
Legal business name
SANDFORD H KINNE III D O P A
Practice address
290 Clyde Morris Blvd
Suite a-1
Ormond Beach, FL 32174-8130
Phone
(386) 677-5600
Fax
(386) 677-5686
NPI assigned
May 20, 2009
Last updated
May 20, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2009

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

Authorized official

Name
Dr. Sandford Halsey Kinne III, DONPI 1043328735
Title
Owner/Self
Phone
(386) 677-5600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS0006791 FL Primary

Addresses

Primary practice location

290 Clyde Morris Blvd
Suite a-1
Ormond Beach, FL 32174-8130

Mailing address

PO Box 731869
Ormond Beach, FL 32173-1869
Phone (386) 677-5600

Other identifiers 1

IdentifierTypeStateIssuer
375409000MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090616000324 FL Part B Supplier - Clinic/Group Practice 2062562978 Receives reassigned benefits from 1 practitioner
Practice locations: Bunnell, FL; Daytona Beach, FL; Ormond Beach, FL

National Provider Directory

National Provider Directory

Locations

550 National Health Care Dr
#D
Daytona Beach, FL 32114
Phone (386) 257-6362

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1242777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242777600000",
    "number": "1942435920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 731869",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321731869",
            "telephone_number": "386-677-5600",
            "fax_number": "386-677-5686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 CLYDE MORRIS BLVD",
            "address_2": "SUITE A-1",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321748130",
            "telephone_number": "386-677-5600",
            "fax_number": "386-677-5686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDFORD H KINNE III D O P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-20",
        "last_updated": "2009-05-20",
        "status": "A",
        "authorized_official_last_name": "KINNE",
        "authorized_official_first_name": "SANDFORD",
        "authorized_official_middle_name": "HALSEY",
        "authorized_official_title_or_position": "OWNER/SELF",
        "authorized_official_telephone_number": "386-677-5600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS0006791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "375409000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ormond Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.