Individual provider Active NPI

Dwayne P Vanderberg, M.D.

  • Internal Medicine Physician
  • Olivehurst, CA
National Provider Identifier
1225012008
Registry record updated Feb 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G73626 Issued in CA
Practice address
4941 Olivehurst Ave
Olivehurst, CA 95961-4225
Phone
(530) 743-4611
Fax
(530) 743-5770
NPI assigned
Dec 5, 2005
Last updated
Feb 26, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G73626 CA Primary

Addresses

Primary practice location

4941 Olivehurst Ave
Olivehurst, CA 95961-4225

Mailing address

PO Box Ad
Yuba City, CA 95992-1396
Phone (800) 313-0111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041118000564 CA Practitioner - Internal Medicine 5193789139 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Loma Linda University School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ampla HealthGroup PAC ID 5092619270, 105 clinicians

Practice addresses (Care Compare)

4941 Olivehurst Ave
Olivehurst, CA 95961-4225
Phone (530) 743-4611

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G73626CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ampla Health CurrentSince Jun 8, 2010 Accepting new patients
Ampla Health CurrentSince Jun 8, 2010 Accepting new patients
Ampla Health Current Accepting new patients
Ampla Health Past Accepting new patients

Locations

4941 Olivehurst Ave
Olivehurst, CA 95961
Phone (530) 743-4611

2800 Lincoln St
Oroville, CA 95966
Phone (530) 534-7500

935 Market St
Yuba City, CA 95991
Phone (530) 674-4261

Interoperability endpoints

  • Direct secure messaging: dwayne.vanderberg@ampla.eclinicaldirectplus.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772064000000",
    "number": "1225012008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX AD",
            "city": "YUBA CITY",
            "state": "CA",
            "postal_code": "959921396",
            "telephone_number": "800-313-0111",
            "fax_number": "530-751-1237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4941 OLIVEHURST AVE",
            "city": "OLIVEHURST",
            "state": "CA",
            "postal_code": "959614225",
            "telephone_number": "530-743-4611",
            "fax_number": "530-743-5770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERBERG",
        "first_name": "DWAYNE",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-05",
        "last_updated": "2026-02-26",
        "certification_date": "2026-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G73626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olivehurst, CA

Sources for this page

Verify at the official NPI Registry.