NPIMap

Individual provider Active NPI

Sierra Dawn Vanderkelen, MD

  • Family Medicine Physician
  • Greenville, SC
National Provider Identifier
1104388065
Registry record updated Aug 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
90637 Issued in SC
Practice address
215 Halton Rd
Greenville, SC 29607-3509
Phone
(864) 454-2700
Fax
(864) 288-5082
NPI assigned
Apr 1, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 125075043 IL
Family Medicine Physician 207Q00000X 036.160037 IL
Family Medicine Physician 207Q00000X 90637 SC Primary

Addresses

Primary practice location

215 Halton Rd
Greenville, SC 29607-3509

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8603

Other practice location 1

750 N Orleans St Ste 101
Chicago, IL 60654-5051
Phone (312) 566-4210

Other practice location 2

1775 Ballard Rd
Park Ridge, IL 60068-1005
Phone (847) 318-6020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20231127000806 SC Practitioner - Family Practice 2163870593 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York Medical College, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

215 Halton Rd
Greenville, SC 29607-3509
Phone (864) 522-1320

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.160037ILMDFamily Medicine Physician
125075043ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Sep 18, 2023 Accepting new patients
Prisma Health University Medical Group Family Medicine CurrentSince Sep 18, 2023 Accepting new patients

Locations

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

2A Cleveland Ct
Greenville, SC 29607
Phone (864) 271-7761

215 Halton Rd
Greenville, SC 29607
Phone (864) 454-2700

Interoperability endpoints

  • Direct secure messaging: svanderkelen728305@direct.ghs.myhfn.org

Organizations & group practices 2

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 52

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

View all 52

NPI Registry JSON

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

{
    "created_epoch": "1554076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692662400000",
    "number": "1104388065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 HALTON RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296073509",
            "telephone_number": "864-454-2700",
            "fax_number": "864-288-5082"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "750 N Orleans St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606545051",
            "country_code": "US",
            "telephone_number": "312-566-4210",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1775 Ballard Rd",
            "address_purpose": "LOCATION",
            "city": "Park Ridge",
            "state": "IL",
            "postal_code": "600681005",
            "country_code": "US",
            "telephone_number": "847-318-6020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDERKELEN",
        "first_name": "SIERRA",
        "middle_name": "DAWN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-01",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125075043",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.160037",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "90637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.