Individual provider Active NPI

Erik Dean Sandstrom, M.D.

  • Family Medicine Physician
  • Havre, MT
National Provider Identifier
1962473173
Registry record updated May 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
04-27976 Issued in KS
Practice address
30 13TH St
Havre, MT 59501-5222
Phone
(406) 265-2211
Fax
(406) 262-1615
NPI assigned
Jan 27, 2006
Last updated
May 17, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 04-27976 KS Primary

Addresses

Primary practice location

30 13TH St
Havre, MT 59501-5222

Mailing address

PO Box 1231
Havre, MT 59501-1231
Phone (406) 265-2211

Other practice location 1

506 Thorpe St
Lakin, KS 67860
Phone (620) 355-7550

Other identifiers 1

IdentifierTypeStateIssuer
100347630AMedicaidKS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241115003520 NM Practitioner - Family Practice 5991741217 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
04-27976KSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Presbyterian Healthcare Services Family Medicine CurrentSince Nov 1, 2024 Accepting new patients
Presbyterian Healthcare Services CurrentSince Nov 1, 2024 Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

5901 Harper Dr NE
Albuquerque, NM 87109
Phone (505) 823-8233

2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577

Organizations & group practices 3

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": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684281600000",
    "number": "1962473173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1231",
            "city": "HAVRE",
            "state": "MT",
            "postal_code": "595011231",
            "telephone_number": "406-265-2211",
            "fax_number": "406-262-1615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 13TH ST",
            "city": "HAVRE",
            "state": "MT",
            "postal_code": "595015222",
            "telephone_number": "406-265-2211",
            "fax_number": "406-262-1615"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "506 THORPE ST",
            "address_purpose": "LOCATION",
            "city": "LAKIN",
            "state": "KS",
            "postal_code": "67860",
            "country_code": "US",
            "telephone_number": "620-355-7550",
            "fax_number": "620-355-7500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDSTROM",
        "first_name": "ERIK",
        "middle_name": "DEAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-27",
        "last_updated": "2023-05-17",
        "certification_date": "2023-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "04-27976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100347630A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Havre, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2023; 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.