Individual provider Active NPI

Cassandra Lee Vandenberg, PA-C

  • Physician Assistant
  • Clear Lake, IA
National Provider Identifier
1083375711
Registry record updated Nov 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
112254 Issued in IA
Practice address
1410 6TH Ave S
Clear Lake, IA 50428-2606
Phone
(641) 357-2191
Fax
(641) 357-6020
NPI assigned
Jan 5, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 112254 IA Primary

Addresses

Primary practice location

1410 6TH Ave S
Clear Lake, IA 50428-2606

Mailing address

PO Box 653
Cascade, IA 52033-0653
Phone (641) 247-8214

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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

Enrollment IDStateProvider typePAC IDDetails
I20220215000387 IA Practitioner - Physician Assistant 4183017106 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Iowa Physicians Clinic Medical FoundationGroup PAC ID 8729992318, 1,254 clinicians

Practice addresses (Care Compare)

1001 N Ctr Point Rd
Suite C
Hiawatha, IA 52233-1237
Phone (319) 362-0200

4480 Utica Ridge Rd
Bettendorf, IA 52722-1644

Hospital & facility affiliations

  • St Lukes Hospital Hospital, Cedar Rapids, IA, CCN 160045

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
112254IAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Iowa Physicians Clinic Medical Foundation CurrentSince Oct 23, 2023 Accepting new patients
Iowa Physicians Clinic Medical Foundation Physician Assistant CurrentSince Oct 23, 2023 Accepting new patients
St Luke'S Methodist Hospital Current Accepting new patients
Floyd County Memorial Hospital Commission Past Accepting new patients

Locations

4480 Utica Ridge Rd
Ste 160
Bettendorf, IA 52722
Phone (563) 742-5950

4480 Utica Ridge Rd
Ste 2230
Bettendorf, IA 52722
Phone (563) 742-5150

1001 N Center Point Rd
Ste C
Hiawatha, IA 52233
Phone (319) 362-0200

Interoperability endpoints

  • Direct secure messaging: cvandenberg795674@direct.unitypoint.org

Organizations & group practices 4

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 1

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": "1641340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700092800000",
    "number": "1083375711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 653",
            "city": "CASCADE",
            "state": "IA",
            "postal_code": "520330653",
            "telephone_number": "641-247-8214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1410 6TH AVE S",
            "city": "CLEAR LAKE",
            "state": "IA",
            "postal_code": "504282606",
            "telephone_number": "641-357-2191",
            "fax_number": "641-357-6020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDENBERG",
        "first_name": "CASSANDRA",
        "middle_name": "LEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-05",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "112254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clear Lake, IA

Sources for this page

Verify at the official NPI Registry.