WOUND COMPANY PROVIDER GROUP, INC.
NPI 1114635174
Registered Nurse - Wound Care in Minneapolis, MN
About Wound Company Provider Group, Inc. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
WOUND COMPANY PROVIDER GROUP, INC. (NPI 1114635174), doing business as Sanford E Roberts Iii Md, Inc., is a healthcare organization registered as a wound care in Minneapolis, Minnesota and active in the NPI registry since November 2022. The organization lists Brantley Tilman Jolly, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 3
Other Names 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Wound Company Provider Group, Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
7Medicare enrollment records show 7 clinicians reassign Medicare billing to Wound Company Provider Group, Inc., which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.
Clinicians, nearest first (7)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Wound Company Provider Group, Inc.'s NPI number?
The NPI number for Wound Company Provider Group, Inc. is 1114635174. It was assigned to this organization in the NPPES registry on November 9, 2022. The provider was formerly known as Sanford E Roberts III MD, Inc..
Where is Wound Company Provider Group, Inc. located?
Wound Company Provider Group, Inc. is located at 2240 Drew Ave S, Minneapolis, MN 55416. The listed phone number is (858) 774-6305.
What is Wound Company Provider Group, Inc.'s specialty?
The primary specialty registered for this NPI is Registered Nurse, specializing in Wound Care, with taxonomy code 163WW0000X.
Is Wound Company Provider Group, Inc. enrolled in Medicare?
Yes. Wound Company Provider Group, Inc. is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Wound Company Provider Group, Inc.?
According to the CMS Revalidation Reassignment List (October 2026 release), 7 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Wound Company Provider Group, Inc.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Wound Company Provider Group, Inc. accept?
Health plans from Blue Cross and Blue Shield of Texas list Wound Company Provider Group, Inc. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Wound Company Provider Group, Inc. was last updated on July 18, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Wound Company Provider Group, Inc. · NPI 1114635174
Wound Care organization in Minneapolis, Minnesota. Organization record, active in the CMS NPPES registry since November 9, 2022.
## Identity
- **NPI:** 1114635174 (Entity type: Organization)
- **Enumerated:** November 9, 2022
- **Primary specialty:** Registered Nurse - Wound Care · taxonomy 163WW0000X
- **Organization subpart:** No
- **Authorized official:** Brantley Jolly, PRESIDENT
## Practice location
- **Address:** 2240 DREW AVE S, Minneapolis, MN 55416-3646
- **Phone:** (858) 774-6305
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 7 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 2 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 18, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1114635174) · Data from the CMS NPPES public registry.