Jesse Sandoval, D.O.

Primary specialty

Phlebology PhysicianTaxonomy code 202K00000X

License

O124 Issued in ID

Practice address

245 N Binkley St Ste 101
Soldotna, AK 99669-7500

Phone

(907) 714-4111

Fax

(907) 262-5191

NPI assigned

May 6, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 12

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in AK, TX2 enrollments

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 2

Merit-based Incentive Payment System (MIPS)

Final score

75.44 of 100Reported as group

Quality

62.56

Promoting interoperability

81

Improvement activities

40

Cost

67.88

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jsandoval927215@ak.providencedirect.org

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.

• Central Peninsula General Hospital Inc.

  • Rural Acute Care Hospital
  • Soldotna, AK
  • NPI 1528062429
  Medicare reassignment NPD
• Metlakatla Indian Community

  • Health Service Clinic/Center
  • Metlakatla, AK
  • NPI 1740294081

  TX

  Medicare reassignment NPD
• Central Peninsula General Hospital, Inc

  • Family Medicine Physician
  • Soldotna, AK
  • NPI 1538631478
  NPD
• North Star Medical Imaging PLLC

  • Diagnostic Radiology Physician
  • Mount Vernon, WA
  • NPI 1144489824
  NPD

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

{
    "created_epoch": "1146873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702944000000",
    "number": "1972552271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7130",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837071130",
            "telephone_number": "208-333-1472",
            "fax_number": "208-333-7757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 N BINKLEY ST STE 101",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996697500",
            "telephone_number": "907-714-4111",
            "fax_number": "907-262-5191"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1199 Shoreline Ln",
            "address_2": "#310",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837026813",
            "country_code": "US",
            "telephone_number": "208-333-1472",
            "fax_number": "208-333-7757",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "247 N Fireweed St Ste A",
            "address_purpose": "LOCATION",
            "city": "Soldotna",
            "state": "AK",
            "postal_code": "996697593",
            "country_code": "US",
            "telephone_number": "907-262-8597",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDOVAL",
        "first_name": "JESSE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-06",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "0124",
            "primary": false
        },
        {
            "code": "202K00000X",
            "taxonomy_group": "",
            "desc": "Phlebology",
            "state": "ID",
            "license": "O124",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "S4620",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIMARY HEALTH NETWORK",
            "identifier": "200489062",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE WEST",
            "identifier": "200489062",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0004676625",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRINCIPAL LIFE INSURANCE",
            "identifier": "200489062",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004314700",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MUTUAL OF OMAHA",
            "identifier": "200489062",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HCS HEALTH CLAIMS SERVICE",
            "identifier": "200489062",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHEILD",
            "identifier": "000010145826",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "200489062",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HEALTH CARE",
            "identifier": "200489062",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "200489062",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jsandoval927215@ak.providencedirect.org",
            "affiliation": "N",
            "endpointDescription": "Provider direct messaging address",
            "address_1": "506 Lake St",
            "city": "Kenai",
            "state": "AK",
            "country_code": "US",
            "postal_code": "996116937",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jsandoval927215@ak.providencedirect.org",
            "affiliation": "N",
            "endpointDescription": "Provider direct messaging address",
            "address_1": "247 N Fireweed St Ste A",
            "city": "Soldotna",
            "state": "AK",
            "country_code": "US",
            "postal_code": "996697593",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nate Kelly Saltzgiver, PA-C
• Samadhi Center, P.C.
• Sonja Sand, MS OTR/L
• Elizabeth Sanders
• Phil Sanders, R.PH
• Kali Saxton-Shaw, PA-C
• Heather Schaefer
• Lisa Kay Schmitter, LPC, M ED
• Sarah Schoner, FNP
• Samantha Alyse Schrage, PHARM. D.

• Phlebology Physician in Soldotna, AK
• Providers in Soldotna, AK by specialty
• Phlebology Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.