Blake Sanders, DO

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

2021-03162 Issued in NC

Practice address

170 Medical Park Rd Ste 203
Mooresville, NC 28117-8540

Phone

(980) 550-2400

Fax

(980) 550-2424

NPI assigned

Feb 22, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA, NC2 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

Specialty

Dermatology

Education

Des Moines University of Osteopathic Medicine and Health Sciences, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: blake.sanders.1@14847.direct.athenahealth.com

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.

• Sanders Medical Group, PLLC

  • Dermatology Physician
  • Mooresville, NC
  • NPI 1609536267
  Medicare reassignment NPD Authorized official
• Wellspan Medical Group

  • Gastroenterology Physician
  • York, PA
  • NPI 1669770004
  Medicare reassignment NPD
• Wellspan Medical Group

  • Pediatric Surgery Physician
  • York, PA
  • NPI 1104799428
  NPD
• Wellspan Medical Group

  • Family Medicine Physician
  • York, PA
  • NPI 1457044794
  NPD
• Rawles & Associates, PLC

  • Psychologist
  • Newport News, VA
  • NPI 1669631883
  NPD (past)

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

{
    "created_epoch": "1456099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640736000000",
    "number": "1972962710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 MEDICAL PARK RD STE 203",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178540",
            "telephone_number": "980-550-2400",
            "fax_number": "980-550-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 MEDICAL PARK RD STE 203",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178540",
            "telephone_number": "980-550-2400",
            "fax_number": "980-550-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "BLAKE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-22",
        "last_updated": "2021-12-29",
        "certification_date": "2021-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "PA",
            "license": "OS020540",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NC",
            "license": "2021-03162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rosalina Gabrielle Sanchez
• Terri Lynn Sanchez
• Todd Anthony Sandagato, PA
• Taylor White Sandberg, MD
• Sanders Medical Group, PLLC
• Skyler Sanders, PHARMD
• Michelle Sandiford
• Kasie Sands, LCMHCA
• Sannas-24
• Sharon Maria Santhosh

• Dermatology Physician in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Dermatology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2021; 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.