Active NPI
Sondra Suzette Andersen, PA-C
- Medical Physician Assistant
- Goodyear, AZ
National Provider Identifier
1982710240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 3020
- Practice address
- 13555 W McDowell Rd
Suite 104
Goodyear, AZ 85395-2624 - Phone
- (623) 512-4176
- Fax
- (623) 512-4199
- NPI assigned
- Aug 21, 2006
- Last updated
- Oct 23, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 3020 | AZ | Primary |
Addresses
Primary practice location
13555 W McDowell Rd
Suite 104
Goodyear, AZ 85395-2624
Mailing address
9250 N 3Rd St
Suite 4010
Phoenix, AZ 85020-2437
Phone (602) 633-3848
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 922733 | Medicaid | AZ |
Other names 1
- Sam Andersen
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Your Neighborhood Healthcare Center LLC | Past | Accepting new patients | |
| Equality Health at Home Inc | Past | Accepting new patients | |
| Privia Medical Group Arizona, LLC | Past | Accepting new patients |
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.
-
- Family Medicine Physician
- Phoenix, AZ
- NPI 1760441141
-
- Multi-Specialty Clinic/Center
- Scottsdale, AZ
- NPI 1649459231
-
- Internal Medicine Physician
- Frisco, TX
- NPI 1730936329
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1382486400000",
"number": "1982710240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9250 N 3RD ST",
"address_2": "SUITE 4010",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850202437",
"telephone_number": "602-633-3848",
"fax_number": "602-633-3841"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13555 W MCDOWELL RD",
"address_2": "SUITE 104",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853952624",
"telephone_number": "623-512-4176",
"fax_number": "623-512-4199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSEN",
"first_name": "SONDRA",
"middle_name": "SUZETTE",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-21",
"last_updated": "2013-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "AZ",
"license": "3020",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "922733",
"state": "AZ"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SAM",
"last_name": "ANDERSEN",
"credential": "PA-C",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Goodyear, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.