Roberta Nadine Vandentop, PHYSICIAN ASSISTANT

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

1815 SW Marlow Ave
Ste 110
Portland, OR 97225-5185

Phone

(503) 296-0918

Fax

(503) 296-6158

NPI assigned

Oct 18, 2006

Sex

Female

Sole proprietor

Yes

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 OR

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Pain Management Consultants, PC

  • Specialist
  • Tigard, OR
  • NPI 1861692808
  Medicare reassignment
• Pain Management Facility, LLC

  • Specialist
  • Portland, OR
  • NPI 1932309978
  NPD (past)
• Atlantic Radiology Associates PA

  • Diagnostic Radiology Physician
  • Goldsboro, NC
  • NPI 1184656936
  NPD (past)

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124109889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14807 NW APPLEGATE LN",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972291899",
            "telephone_number": "503-747-2572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 SW MARLOW AVE",
            "address_2": "STE 110",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255185",
            "telephone_number": "503-296-0918",
            "fax_number": "503-296-6158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDENTOP",
        "first_name": "ROBERTA",
        "middle_name": "NADINE",
        "name_prefix": "Mrs.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Gregg Vandaam
• Edward Vandehey
• Tara R Vandehey, CADC II/QMHP
• Emily Vandekieft
• Rebekah Elizabeth Vanden Heuvel, CSWA
• Shannon Vandepas, RN
• Jesse Edward Vander Heide
• Tessa Maurine Vander Kamp, RD, LD
• Shena Vander Ploeg
• Gretchen E Vanderbeek, MD

• Medical Physician Assistant in Portland, OR
• Providers in Portland, OR by specialty
• Medical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.