NPIMap

Individual provider Active NPI

Henry John Leonard Van Dyk, MD

  • Internal Medicine Physician
  • Tuba City, AZ
National Provider Identifier
1093751125
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
28767 Issued in WA
Practice address
167 N Main St
Tuba City, AZ 86045-0600
Phone
(928) 283-2501
Fax
(928) 283-2677
NPI assigned
Jun 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 28767 WA Primary

Addresses

Primary practice location

167 N Main St
Tuba City, AZ 86045-0600

Mailing address

PO Box 600
167 North Main Street
Tuba City, AZ 86045-0600
Phone (928) 283-2501

Other identifiers 1

IdentifierTypeStateIssuer
529513MedicaidAZ

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
I20070730000914 TX Practitioner - Internal Medicine 1850492174 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Louisiana State University School of Medicine in New Orleans, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Tuba City Regional Health Care CorporationGroup PAC ID 4284542531, 160 clinicians

Practice addresses (Care Compare)

167 N Main St
Tuba City Indian Medical Center
Tuba City, AZ 86045-0600
Phone (928) 283-2094

Hospital & facility affiliations

  • Tuba City Regional Health Care Corporation Hospital, Tuba City, AZ, CCN 030073
  • Flagstaff Medical Center Hospital, Flagstaff, AZ, CCN 030023

Merit-based Incentive Payment System (MIPS)

Final score
77.59 of 100Reported as group
Quality
47.51
Promoting interoperability
69
Improvement activities
40
Cost
86.96

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
28767WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tuba City Regional Health Care Corporation Internal Medicine Current Accepting new patients
Tuba City Regional Health Care Corporation Internal Medicine CurrentSince Aug 18, 2018 Accepting new patients
DHHS IHS Phoenix Area CurrentSince Sep 16, 2017 Accepting new patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm Past Accepting new patients
Hospital Inpatient Services of Winslow LLC Past Accepting new patients

Organizations & group practices 5

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 5

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": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093751125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 600",
            "address_2": "167 NORTH MAIN STREET",
            "city": "TUBA CITY",
            "state": "AZ",
            "postal_code": "860450600",
            "telephone_number": "928-283-2501",
            "fax_number": "928-283-2677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 N MAIN ST",
            "city": "TUBA CITY",
            "state": "AZ",
            "postal_code": "860450600",
            "telephone_number": "928-283-2501",
            "fax_number": "928-283-2677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DYK",
        "first_name": "HENRY",
        "middle_name": "JOHN LEONARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "28767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529513",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tuba City, AZ

Sources for this page

Verify at the official NPI Registry.