SANDRA L. FORNWALT M.D. NPI 1588660427

Obstetrics & Gynecology (Obstetrics) in Spokane, WA

Individual Female Obstetrics & Gynecology Obstetrics PECOS Enrolled Accepts Medicare Years Experience 37

About SANDRA FORNWALT

Sandra Fornwalt is a provider established in Spokane, Washington and her medical specialization is obstetrics & gynecology with more than 37 years of experience. The NPI number of Sandra Fornwalt is 1588660427 and was assigned on June 2005. The practitioner's primary taxonomy code is 207VX0000X with license number MD00049202 (WA). The provider is registered as an individual and her NPI record was last updated 5 years ago. Sandra Fornwalt is enrolled in PECOS and is registered with Medicare and accepts claims assignment. According to Medicare claims data the provider has hospital affiliations with Providence Sacred Heart Medical Center.

NPI

1588660427

Provider Name SANDRA L. FORNWALT M.D.
Provider Location Address101 W 8TH AVE SUITE 1100 SPOKANE, WA 99204
Provider Mailing AddressPO BOX 421 LIBERTY LAKE, WA 99019
GenderFemale
NPI Entity TypeIndividual
Medical School NameHAHNEMANN UNIVERSITY COLLEGE OF MEDICINE
Graduation Year1983
Is Sole Proprietor?No
Is Organization Subpart?N/A
Enumeration Date06-24-2005
Last Update Date10-21-2015

Primary Taxonomy

Taxonomy Code207VX0000X
ClassificationObstetrics & Gynecology
TypeAllopathic & Osteopathic Physicians
SpecializationObstetrics
License No.MD00049202
License StateWA

Business Address

SANDRA L. FORNWALT M.D.
101 W 8TH AVE
SUITE 1100
SPOKANE, WA
ZIP 99204
Phone: (509) 474-4060
Fax: (509) 474-6198

Get Directions

Mailing Address

SANDRA L. FORNWALT M.D.
PO BOX 421
LIBERTY LAKE, WA
ZIP 99019
Phone: (866) 747-2455

Medicare Participation

Registered in PECOS? Yes What is PECOS?
PECOS is the Medicare Provider, Enrollment, Chain and Ownership System. PECOS is Medicare’s enrollment and revalidation system and it is the primary source of information about verified Medicare professionals. A NPI number is necessary to register in PECOS. Providers must enroll in PECOS to avoid denied claims.
PECOS PAC ID9335199165
PECOS Enrollment IDI20080416000565
Accepts Medicare Assignment? Yes "What does it mean "accepts medicare assignment"?
When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
Part B Clinical Laboratory and ImagingYes
Durable Medical EquipmentYes
Home Health Agency (HHA)Yes
Power Mobility DevicesYes

Hospital Affiliations

Medicare hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the Medicare claims NPI number and place of service code. Additionally, to further determine provider hospital affilition the clinician must have provided services to at least three patients on three different dates in the last 12 months.

Hospital Name Address Phone Hospital Type CMS Certification Number (CCN)
PROVIDENCE SACRED HEART MEDICAL CENTER101 WEST 8TH AVENUE
SPOKANE, WA 99204
Acute Care Hospitals500054

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
407023200MEDICAID (05)MD
E53125MEDICARE UPIN (02)

Other Providers at the same location


The following 20 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1003819319SACRED HEART MEDICAL CENTER
Organization
General Acute Care Hospital (Critical Access)101 W 8TH AVE
SPOKANE, WA 99204
(509) 474-3131
1063480762MR. GARY C GRAY CRNA
Individual
Nurse Anesthetist, Certified Registered101 W 8TH AVE
SPOKANE, WA 99204
(509) 474-3918
1164491007MR. MEHRAN JAFARI KHOSRAVI CRNA
Individual
Nurse Anesthetist, Certified Registered101 W 8TH AVE
SPOKANE, WA 99204
(509) 474-4971
1205887122 JAMES D FISCHER M.D.
Individual
Surgery (Pediatric Surgery)101 W 8TH AVE STE 100
SPOKANE, WA 99204
(509) 474-5445
1215987342DR. DANIEL P BRUTOCAO MD
Individual
Anesthesiology101 W 8TH AVE
SPOKANE, WA 99204
(509) 926-1770
1275583239DR. ROBERT ORVILLE OLSON JR. M.D.
Individual
Obstetrics & Gynecology101 W 8TH AVE
SPOKANE, WA 99204
(509) 474-4060
1295792463 KRISTINE A ECKERT CRNA
Individual
Nurse Anesthetist, Certified Registered101 W 8TH AVE
SPOKANE, WA 99204
(509) 474-4971
1326091299 ZULY VIRULA EDEN PHARMD
Individual
Pharmacist101 W 8TH AVE
SPOKANE, WA 99204
(509) 474-3242
1396714077 JOHN SCOTT WENDELL CRNA
Individual
Nurse Anesthetist, Certified Registered101 W 8TH AVE
SPOKANE, WA 99204
(509) 953-5601
1548210719PEDIATRIC CRITICAL CARE ASSOCIATES PS
Organization
Pediatrics (Pediatric Critical Care Medicine)101 W 8TH AVE
SPOKANE, WA 99204
(509) 474-7461
1548243991DR. FRANK E OTTO M.D.
Individual
Family Medicine101 W 8TH AVE
SPOKANE, WA 99204
(509) 474-6602
1568412013DR. GARY W LEE MD
Individual
Anesthesiology101 W 8TH AVE
SPOKANE, WA 99204
(509) 926-1770
1588625834MS. SHERRY KAY MURR CRNA
Individual
Nurse Anesthetist, Certified Registered101 W 8TH AVE
SPOKANE, WA 99204
(509) 474-4971
1649249640 STEPHEN GILBERT CRNA
Individual
Nurse Anesthetist, Certified Registered101 W 8TH AVE
SPOKANE, WA 99204
(509) 474-4971
1770547887MRS. HEATHER THERESE JOHNSON CHRISTENSEN CRNA
Individual
Nurse Anesthetist, Certified Registered101 W 8TH AVE
SPOKANE, WA 99204
(509) 474-4971
1801855408 WINSTON CHAN
Individual
Surgery (Pediatric Surgery)101 W 8TH AVE L1 STE 100
SPOKANE, WA 99204
(509) 474-5445
1881658508 MARK ROBERT STRUBE CRNA
Individual
Nurse Anesthetist, Certified Registered101 W 8TH AVE
SPOKANE, WA 99204
(509) 474-4971
1902895865MS. MARGARET RUTH MEYERS CRNA
Individual
Nurse Anesthetist, Certified Registered101 W 8TH AVE
SPOKANE, WA 99204
(509) 474-4971
1932151768DR. PETER W GRAVES MD
Individual
Anesthesiology101 W 8TH AVE
SPOKANE, WA 99204
(509) 926-1770
1952351082DR. JAMES DALE MELLEMA MD
Individual
Anesthesiology101 W 8TH AVE
SPOKANE, WA 99204
(509) 926-1770

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.