NPIMap

Individual provider Active NPI

Ian Vandergulik, DPM

  • Foot & Ankle Surgery Podiatrist
  • San Antonio, TX
National Provider Identifier
1033733852
Registry record updated Nov 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
692084 Issued in TX
Practice address
5282 Medical Dr Ste 260
San Antonio, TX 78229-6039
Phone
(210) 970-7802
NPI assigned
Jun 8, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 692084 TX Primary

Addresses

Primary practice location

5282 Medical Dr Ste 260
San Antonio, TX 78229-6039

Mailing address

5282 Medical Dr Ste 260
San Antonio, TX 78229-6039
Phone (860) 770-5113

Other practice location 1

420 Water St Ste 107
Kerrville, TX 78028-5200
Phone (830) 282-8226

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231024002651 TX Practitioner - Podiatry 7214383496 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hill Country Foot Surgeons PAGroup PAC ID 7214986702, 2 clinicians
South Texas Foot Surgeons, P.a.Group PAC ID 3274574496, 2 clinicians

Practice addresses (Care Compare)

420 Water St
Kerrville, TX 78028-5200
Phone (830) 895-3400

5282 Medical Dr
Suite 260
San Antonio, TX 78229-6039
Phone 21061608192

Hospital & facility affiliations

  • Peterson Regional Medical Center Hospital, Kerrville, TX, CCN 450007
  • Methodist Hospital Hospital, San Antonio, TX, CCN 450388

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue67
Removal of skin lesions1-10
Removal of nail tissue132
Removal or shaving of skin growth14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Sports Medicine Associates of San Antonio, PA Foot & Ankle Surgery CurrentSince Sep 1, 2023 Accepting new patients
Hill Country Foot Surgeons, P.a. Foot & Ankle Surgery CurrentSince Mar 13, 2025 Accepting new patients
South Texas Foot Surgeons, P.a. Foot & Ankle Surgery CurrentSince Jan 14, 2026 Accepting new patients
Sports Medicine Associates of San Antonio, PA CurrentSince Sep 1, 2023 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Sports Medicine Associates of San Antonio, PA Past Accepting new patients

Locations

420 Water St
Ste 107
Kerrville, TX 78028
Phone (830) 895-3400

21 Spurs Ln
Ste 300
San Antonio, TX 78240
Phone (210) 561-7137

5282 Medical Dr
Ste 260
San Antonio, TX 78229
Phone (210) 616-0819

5921 Broadway
San Antonio, TX 78209
Phone (210) 822-8326

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 6

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1591574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1033733852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5282 MEDICAL DR STE 260",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782296039",
            "telephone_number": "860-770-5113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5282 MEDICAL DR STE 260",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782296039",
            "telephone_number": "210-970-7802"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 Water St Ste 107",
            "address_purpose": "LOCATION",
            "city": "Kerrville",
            "state": "TX",
            "postal_code": "780285200",
            "country_code": "US",
            "telephone_number": "830-282-8226",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDERGULIK",
        "first_name": "IAN",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-08",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "TX",
            "license": "692084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.