Individual provider Active NPI

Tony Wayne Vanderpool, D.C.

  • Chiropractor
  • Mt Pleasant, SC
National Provider Identifier
1093763732
Registry record updated Aug 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
SC2149 Issued in SC
Practice address
1965 Riviera Dr
Suite 3
Mt Pleasant, SC 29464-7469
Phone
(843) 884-7100
Fax
(843) 884-7340
NPI assigned
May 5, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 30, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X SC2149 SC Primary

Addresses

Primary practice location

1965 Riviera Dr
Suite 3
Mt Pleasant, SC 29464-7469

Mailing address

1965 Riviera Dr
Suite 3
Mt Pleasant, SC 29464-7469
Phone (843) 884-7100

Other identifiers 1

IdentifierTypeStateIssuer
CH2149MedicaidSC

Other names 1

  • Dr. Anthony Wayne Vanderpool Professional name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110906000171 SC Practitioner - Chiropractic 3274703053 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 1995
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1965 Riviera Dr
Suite 3
Mount Pleasant, SC 29464-7469
Phone (843) 884-7100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SC2149SCMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Natural Health Center, Inc Chiropractor CurrentSince Oct 19, 2011 Accepting new patients

Locations

1965 Riviera Dr
Unit 3
Mt Pleasant, SC 29464
Phone (843) 884-7100

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314662400000",
    "number": "1093763732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1965 RIVIERA DR",
            "address_2": "SUITE 3",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294647469",
            "telephone_number": "843-884-7100",
            "fax_number": "843-884-7340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1965 RIVIERA DR",
            "address_2": "SUITE 3",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294647469",
            "telephone_number": "843-884-7100",
            "fax_number": "843-884-7340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERPOOL",
        "first_name": "TONY",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2011-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "SC",
            "license": "SC2149",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CH2149",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANTHONY",
            "last_name": "VANDERPOOL",
            "middle_name": "WAYNE",
            "prefix": "DR.",
            "credential": "D.C.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Mt Pleasant, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.