Elyse Verdeyen, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2024022556 Issued in MO

Practice address

110 Business Park Dr Ste C
Branson, MO 65616-7449

Phone

(417) 336-0033

Fax

(855) 710-6552

NPI assigned

Jul 27, 2020

Last updated

Dec 5, 2024By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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

Specialty

Physician Assistant

Education

Wake Forest University School of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatology and Mohs Surgery Skin Cancer CenterGroup PAC ID 8527447945, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Dermatology and Mohs Surgery Skin Cancer Center

  • Dermatology Physician
  • Branson, MO
  • NPI 1124763479
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1595808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733356800000",
    "number": "1104435163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 BUSINESS PARK DR STE C",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656167449",
            "telephone_number": "417-336-0033",
            "fax_number": "855-710-6552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BUSINESS PARK DR STE C",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656167449",
            "telephone_number": "417-336-0033",
            "fax_number": "855-710-6552"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1230 E Kingsley St Ste A&b",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658047211",
            "country_code": "US",
            "telephone_number": "417-336-0033",
            "fax_number": "855-710-6552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "914 Alexis",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "MO",
            "postal_code": "655366802",
            "country_code": "US",
            "telephone_number": "417-336-0033",
            "fax_number": "855-710-6552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10101 Stoltz Dr",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "654017714",
            "country_code": "US",
            "telephone_number": "417-336-0033",
            "fax_number": "855-710-6552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VERDEYEN",
        "first_name": "ELYSE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-27",
        "last_updated": "2024-12-05",
        "certification_date": "2024-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2024022556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffery L Tucker, OT
• Kevin Donald Umbright, O.D.
• Molly Elizabeth Vahldick, FNP-C
• Zach T Vahldick, D.C
• Lacey R Vanemburg, CRNA
• Matthew Vermillion
• Donald N Vespa, DDS
• Justin Brandon Virtue, PHARM D
• Nicholas Vogel
• Ashden Vogler-Blake, FNP

• Physician Assistant in Branson, MO
• Providers in Branson, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2024; 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.
• 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.