Kevin Vandokkumburg, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

5601007350 Issued in MI

Practice address

2144 E Paris Ave SE Ste 240
Grand Rapids, MI 49546-6117

Phone

(616) 949-8945

Fax

(616) 949-1115

NPI assigned

Apr 3, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

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

Rush Medical College of Rush University, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Western Michigan Bone and Joint Surgeons PCGroup PAC ID 8224128194, 5 clinicians

Center for Physical Rehabilitation IncGroup PAC ID 6901717768, 352 clinicians

Center for Physical Rehabilitation and Therapy LPGroup PAC ID 0941513303, 365 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Spectrum Health Hospital, Grand Rapids, MI, CCN 230038

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Western Michigan Bone & Joint Surgeons PC

  • Specialist
  • Grand Rapids, MI
  • NPI 1386756708
  Medicare reassignment Care Compare group
• Center for Physical Rehabilitation and Therapy LP

  • Physical Therapy Clinic/Center
  • Grand Rapids, MI
  • NPI 1902288863
  Care Compare group

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

• Pennock Hospital

  • Critical Access Hospital
  • Hastings, MI
  • NPI 1932695525
  Care Compare affiliation
• Spectrum Health Hospitals

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1922090554
  Care Compare affiliation

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

{
    "created_epoch": "1428019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686528000000",
    "number": "1134514490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2144 E PARIS AVE SE STE 240",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466117",
            "telephone_number": "616-949-8945",
            "fax_number": "616-949-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2144 E PARIS AVE SE STE 240",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466117",
            "telephone_number": "616-949-8945",
            "fax_number": "616-949-1115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDOKKUMBURG",
        "first_name": "KEVIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-03",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601007350",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "5601007350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1134514490",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Courtney Ann Vandewege, ATC
• Veronica Sarah Vandewege, NP
• Laurie Vandezande
• Luke Vandezande, MD
• Angela Marie Vandine, PA-C
• Allison Marie Vandoorne, LLMSW
• Kimberly J Vandorp, PHARM-D
• Douglas M Vandrie, M.D.
• Sara Vandrie, ETS, GCDF
• Courtney Vandriel, RN, IBCLC

• Surgical Physician Assistant in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Surgical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; 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.