Kimberly Carol Vandalen

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN.CNP.025839 Issued in OH

Practice address

193 S Progress Dr
Xenia, OH 45385-2673

Phone

(937) 372-7583

NPI assigned

Nov 12, 2015

Last updated

Oct 22, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other identifiers 7

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mvhe Inc

  • Family Medicine Physician
  • Moraine, OH
  • NPI 1659504785
  Medicare reassignment NPD
• Mvhe Inc

  dba Middletown Medical Group

  • Internal Medicine Physician
  • Middletown, OH
  • NPI 1497154827
  NPD
• Mvhe, Inc

  dba Atrium Hospitalist Group

  • Hospitalist Physician
  • Middletown, OH
  • NPI 1023459401
  NPD
• Uvpc Specialists Inc.

  • Surgery Physician
  • Troy, OH
  • NPI 1831115492
  NPD (past)

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

{
    "created_epoch": "1447286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1053784009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "193 S PROGRESS DR",
            "city": "XENIA",
            "state": "OH",
            "postal_code": "453852673",
            "telephone_number": "937-372-7583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "193 S PROGRESS DR",
            "city": "XENIA",
            "state": "OH",
            "postal_code": "453852673",
            "telephone_number": "937-372-7583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDALEN",
        "first_name": "KIMBERLY",
        "middle_name": "CAROL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-12",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.025839",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP129610",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "AP129610",
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "TX",
            "license": "AP129610",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TX",
            "license": "AP129610",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "083850001",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "87V601",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0389946",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS STATE LICENSE",
            "identifier": "AP129610",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017801401",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "063389301",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "87V600",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "REST",
            "endpointTypeDescription": "RESTful URL",
            "endpoint": "kvandalen1666423@direct.premierhealth.com",
            "affiliation": "N",
            "address_1": "193 S Progress Dr",
            "city": "Xenia",
            "state": "OH",
            "country_code": "US",
            "postal_code": "453852673",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Paul Turner
• Phillip Turner
• Cheyenne Turvey, RN
• Rita Underwood
• Amanda Van Tress
• Angela Vandyke
• Jeremiah Vaughan
• Kelsy Vaughan
• Spring Vaughen
• Constant Faith Vellia

• Family Nurse Practitioner in Xenia, OH
• Providers in Xenia, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.