Kenneth J Vanderbeck, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA21190 Issued in CA

Practice address

23181 Verdugo Dr Ste 103a
Laguna Hills, CA 92653-1313

Phone

(949) 366-1053

NPI assigned

Aug 12, 2010

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

Medicare fee-for-service enrollment

Enrolled in FL, CA, TX3 enrollments

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 3

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jurkowski Medical CorporationGroup PAC ID 7911155304, 16 clinicians

Two Zeds Medical CorporationGroup PAC ID 7810291291, 14 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Jurkowski Medical Corporation

  dba MD Today Urgent Care

  • Urgent Care Clinic/Center
  • San Diego, CA
  • NPI 1750644258
  Medicare reassignment Care Compare group NPD
• Two Zeds Medical Corporation

  dba MD Today Urgent Care

  • Urgent Care Clinic/Center
  • San Diego, CA
  • NPI 1275909434
  Medicare reassignment Care Compare group NPD
• Sharp Rees-Stealy Medical Group, Inc

  • Internal Medicine Physician
  • San Diego, CA
  • NPI 1285616177

  Physician Assistant

  Medicare reassignment NPD
• Pine Ridge Indian Health Service Hospital

  dba Pine Ridge IHS Hospital

  • General Acute Care Hospital
  • Pine Ridge, SD
  • NPI 1497786412

  TX

  Medicare reassignment NPD
• Alvarado Emergency Medical Associates, Inc.

  • Emergency Medicine Physician
  • San Diego, CA
  • NPI 1285811992
  Medicare reassignment
• Cep America - California

  dba Vituity

  • Emergency Medicine Physician
  • Santa Ana, CA
  • NPI 1548667843
  Medicare reassignment
• Clinic Services of California Medical Group Inc

  • Emergency Medicine Physician
  • Lodi, CA
  • NPI 1578958450
  Medicare reassignment
• Emergency and Acute Care Medical Corporation

  • Emergency Medicine Physician
  • San Diego, CA
  • NPI 1437103942
  Medicare reassignment
• Housecall Doctors Medical Group Inc

  • Geriatric Medicine (Family Medicine) Physician
  • Long Beach, CA
  • NPI 1033164017
  Medicare reassignment
• Pacific Paradise Emergency Physicians Medical Group Inc

  • Emergency Medicine Physician
  • National City, CA
  • NPI 1780066076
  Medicare reassignment
• Team Physicians of Northern California Medical Group Inc

  • Emergency Medicine Physician
  • Pleasanton, CA
  • NPI 1649692716
  Medicare reassignment
• Mecnb, LLC

  dba Helix Medical

  • General Practice Physician
  • Palm Springs, FL
  • NPI 1427209352
  Medicare reassignment

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

{
    "created_epoch": "1281571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651190400000",
    "number": "1144535220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8765 AERO DR",
            "address_2": "SUITE 130",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92123",
            "telephone_number": "858-541-0181",
            "fax_number": "858-430-0919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23181 VERDUGO DR STE 103A",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926531313",
            "telephone_number": "949-366-1053"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8765 Aero Dr",
            "address_2": "Suite 130",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "92123",
            "country_code": "US",
            "telephone_number": "858-541-0181",
            "fax_number": "858-430-0919",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDERBECK",
        "first_name": "KENNETH",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-12",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9105536",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA21190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carissa Rae Van Mierlo
• Donna Kaye Van Nieuwenhuyzen
• Andrea Rose Van Ry
• Hohai Truong Van, MD
• Rochelle Ann Vander Tuig
• Vivienne Varga, LPA
• Gauri Varma-Chuhan, PTA
• Rosario Vasconcelos
• Leslie Vazquez
• Carly Lauren Veazey

• Medical Physician Assistant in Laguna Hills, CA
• Providers in Laguna Hills, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2022; 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.