Individual provider Active NPI

Elizabeth Danner Vandel, PA-C

  • Physician Assistant
  • Woodstock, GA
National Provider Identifier
1215168133
Registry record updated Aug 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
005583 Issued in GA
Practice address
203 Woodpark PL
Building C
Woodstock, GA 30188-3705
Phone
(770) 926-4150
Fax
(770) 926-0594
NPI assigned
Jul 28, 2009
Last updated
Aug 27, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2012

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 005583 GA Primary

Addresses

Primary practice location

203 Woodpark PL
Building C
Woodstock, GA 30188-3705

Mailing address

203 Woodpark PL
Building C
Woodstock, GA 30188-3705
Phone (770) 926-4150

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20091109000447 GA Practitioner - Physician Assistant 4082752282 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
005583GAMDRehabilitation Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Aylo Health, LLC Past Accepting new patients
Aylo Health, LLC Past Accepting new patients
Aylo Health, LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: elizabeth.vandel.1@20065.direct.athenahealth.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1248739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346025600000",
    "number": "1215168133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 WOODPARK PL",
            "address_2": "BUILDING C",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301883705",
            "telephone_number": "770-926-4150",
            "fax_number": "770-926-0594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 WOODPARK PL",
            "address_2": "BUILDING C",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301883705",
            "telephone_number": "770-926-4150",
            "fax_number": "770-926-0594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDEL",
        "first_name": "ELIZABETH",
        "middle_name": "DANNER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-28",
        "last_updated": "2012-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "005583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodstock, GA

Sources for this page

Verify at the official NPI Registry.