Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Jody Lee Sanderson, PA-C

Individual provider Medical Physician Assistant · NPI 1164490579

Mr. Jody Lee Sanderson, PA-C is a Physician Assistant in Phoenix, Arizona. Qualified in 2000, 26 years ago. Practices with Smi Imaging LLC, a 376-clinician group and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
26
Licensed in
AZ
In the registry since
2006
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1111 E McDowell Rd
Phoenix, AZ 85006-2612
Phone: (602) 839-6968
Fax: (602) 839-4144
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 2580 (AZ)

Record details

NPI number1164490579
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMarch 10, 2006
Last updated in NPPESJuly 29, 2014

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2000 (26 years in practice)
Group practice Smi Imaging Llc — 376 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations39 on file with Medicare

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