Individual provider Active NPI

John E Vandever, PA-C

  • Physician Assistant
  • Glen Burnie, MD
National Provider Identifier
1164468997
Registry record updated Feb 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C0002477 Issued in MD
Practice address
200 Hospital Dr FL 2
Glen Burnie, MD 21061-5884
Phone
(410) 768-5555
Fax
(410) 768-5835
NPI assigned
Jun 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C0002477 MD Primary

Addresses

Primary practice location

200 Hospital Dr FL 2
Glen Burnie, MD 21061-5884

Mailing address

200 Hospital Dr FL 2
Glen Burnie, MD 21061-5884
Phone (410) 768-5555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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

Enrollment IDStateProvider typePAC IDDetails
I20041123001223 MD Practitioner - Physician Assistant 2769447259 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centers for Advanced Orthopaedics LLCGroup PAC ID 8123260981, 599 clinicians

Practice addresses (Care Compare)

10710 Charter Dr
Suite 300
Columbia, MD 21044-3260
Phone (410) 644-1880

200 Hospital Dr
Glen Burnie, MD 21061-5884
Phone (410) 768-5555

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Centers for Advanced Orthopaedics, LLC CurrentSince Aug 29, 2016 Accepting new patients
Centers for Advanced Orthopaedics, LLC CurrentSince Aug 29, 2016 Accepting new patients
Orthopaedic Associates of Central Maryland, PA Past Accepting new patients
Eastern Shore Orthopaedics Past Accepting new patients

Locations

10710 Charter Dr
Ste 300
Columbia, MD 21044
Phone 4106441880450

200 Hospital Dr
Ste 300
Glen Burnie, MD 21061

200 Hospital Dr
Fl 2
Glen Burnie, MD 21061
Phone (410) 768-5555

200 Hospital Dr
Glen Burnie, MD 21061
Phone (410) 768-5555

7556 Teague Rd
Ste 240
Hanover, MD 21076
Phone (410) 768-5555

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709078400000",
    "number": "1164468997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HOSPITAL DR FL 2",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210615884",
            "telephone_number": "410-768-5555",
            "fax_number": "410-768-5835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HOSPITAL DR FL 2",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210615884",
            "telephone_number": "410-768-5555",
            "fax_number": "410-768-5835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDEVER",
        "first_name": "JOHN",
        "middle_name": "E",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-21",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0002477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Burnie, MD

Sources for this page

Verify at the official NPI Registry.