Kayla Rene Vanderwall, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

7430 N Shadeland Ave Ste 200
Indianapolis, IN 46250-2036

Phone

(317) 621-0668

NPI assigned

Mar 30, 2014

Reactivated

Nov 19, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Community Physicians of Indiana IncGroup PAC ID 1759416662, 1,569 clinicians

Community Physician Network Specialty Care LLCGroup PAC ID 9931697265, 260 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Community Hospital North Hospital, Indianapolis, IN, CCN 150169
• Community Hospital East Hospital, Indianapolis, IN, CCN 150074
• Community Hospital South, Inc. Hospital, Indianapolis, IN, CCN 150128

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kvanderwall524472@ecommunitydirect.com
• Direct secure messaging: kvanderwall201405@direct.edward.org

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.

• Community Physician Network Specialty Care LLC

  • Cardiovascular Disease Physician
  • Indianapolis, IN
  • NPI 1588535496
  Medicare reassignment Care Compare group NPD
• Community Physicians of Indiana Inc

  • Family Medicine Physician
  • Indianapolis, IN
  • NPI 1619105244
  Medicare reassignment Care Compare group NPD

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

• Community Health Network, Inc

  • General Acute Care Hospital
  • Indianapolis, IN
  • NPI 1336119478
  Care Compare affiliation
• Community Health Network, Inc

  • General Acute Care Hospital
  • Indianapolis, IN
  • NPI 1619163854
  Care Compare affiliation
• Community Hospital South, Inc.

  dba Community Hospital South

  • General Acute Care Hospital
  • Indianapolis, IN
  • NPI 1235109778
  Care Compare affiliation

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

{
    "created_epoch": "1396137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661990400000",
    "number": "1164840922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6626 E 75TH ST STE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7430 N SHADELAND AVE STE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502036",
            "telephone_number": "317-621-0668"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "231 Noordewier Hall",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495464417",
            "country_code": "US",
            "telephone_number": "219-743-9368",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7979 N Shadeland Ave Ste 310",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462502042",
            "country_code": "US",
            "telephone_number": "317-621-0668",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 S York St Ste 3280",
            "address_purpose": "LOCATION",
            "city": "Elmhurst",
            "state": "IL",
            "postal_code": "601265638",
            "country_code": "US",
            "telephone_number": "630-646-6020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDERWALL",
        "first_name": "KAYLA",
        "middle_name": "RENE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-30",
        "last_updated": "2022-09-01",
        "certification_date": "2022-09-01",
        "deactivation_date": "2019-11-06",
        "reactivation_date": "2019-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085007328",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kvanderwall201405@direct.edward.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Other",
            "address_1": "1200 S York St Ste 4140",
            "city": "Elmhurst",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601265630",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Samantha Leigh Vanderlaan
• Lisa Vandermeer
• Ellen Vanderpohl
• Charles Phillip Blair Vanderpool, MD
• Joshua Timothy Vanderwall, DO
• Suzanne Vanderweele, FNP-C
• Deborah A Vandevender, NP
• Reese Vandevender, DPT, PT
• Neal Lukas Vandeventer
• Jan Michelle Vandever, MSW

• Surgical Physician Assistant in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Surgical Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 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.