Audrey Victoria Vandewall, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

5101025536 Issued in MI

Practice address

750 E Adams St
Syracuse, NY 13210-2306

Phone

(315) 408-5854

NPI assigned

May 18, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI, PA2 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

Merit-based Incentive Payment System (MIPS)

Final score

80.94 of 100Reported as group

Quality

61.89

Promoting interoperability

100

Improvement activities

40

Cost

74.58

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: audrey.vandewall@upmcdirect.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.

• University of Pittsburgh Physicians

  • Gastroenterology Physician
  • Pittsburgh, PA
  • NPI 1619935004
  Medicare reassignment NPD
• University Pediatricians

  • Pediatrics Physician
  • Detroit, MI
  • NPI 1811920549
  Medicare reassignment NPD
• University of Pittsburgh Physicians

  • Pediatrics Physician
  • Pittsburgh, PA
  • NPI 1225096639
  NPD
• University of Pittsburgh Physicians

  • Diagnostic Radiology Physician
  • Pittsburgh, PA
  • NPI 1285692699
  NPD
• University Pediatricians

  • Pediatrics Physician
  • Detroit, MI
  • NPI 1184471690
  NPD

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

{
    "created_epoch": "1495065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1003343237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102306",
            "telephone_number": "315-408-5854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDEWALL",
        "first_name": "AUDREY",
        "middle_name": "VICTORIA",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-18",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "5101025536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marissa Mae Vanboden
• Michelle Lyla Vandee
• Ella Vanderbilt
• Holly Ann Vanderhoff, PH.D.
• Thomas Jefferson Vandermeer, MD
• Gabrielle Vanduser, LMSW
• Gerda Bernice Vandyck, MSW
• Jennifer Vandyke, NP
• Megan Vanetti, CRNA
• Mattie M Vanglynn, RNNP

• Pediatrics Physician in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2022; 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.