Becky Lee McIlonie Vandeberg, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

652 Issued in ND

Practice address

1702 University Dr S
Fargo, ND 58103-4940

Phone

(701) 364-3300

NPI assigned

Jul 18, 2007

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

Other names 1

• Becky Lee McIlonie Former name

Medicare fee-for-service enrollment

Enrolled in MN, ND2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Optometry

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Innovis Health LLCGroup PAC ID 9931298155, 561 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Essentia Health Hospital, Fargo, ND, CCN 350070

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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.

• Innovis Health, LLC

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1215125463
  Medicare reassignment Care Compare group NPD
• Morrison Eye Care Optometrists, P.a.

  • Optometrist
  • Detroit Lakes, MN
  • NPI 1164517348
  Medicare reassignment NPD
• Innovis Health LLC

  • Multi-Specialty Clinic/Center
  • Fargo, ND
  • NPI 1144776576

  Optometrist

  NPD
• Innovis Health LLC

  • Multi-Specialty Clinic/Center
  • Fargo, ND
  • NPI 1780043257
  NPD
• Morrison Eye Care Optometrists, P.a.

  • Optometrist
  • Mahnomen, MN
  • NPI 1386679033
  NPD
• Lance K Bergstrom MD, PC

  • Specialist
  • Fargo, ND
  • NPI 1801819826

  Optometrist

  NPD (past)

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

• Innovis Health, LLC

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1215125463
  Care Compare affiliation

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

{
    "created_epoch": "1184716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587686400000",
    "number": "1245430370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034940",
            "telephone_number": "701-364-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1244 Washington Ave",
            "address_purpose": "LOCATION",
            "city": "Detroit Lakes",
            "state": "MN",
            "postal_code": "565013906",
            "country_code": "US",
            "telephone_number": "218-847-2020",
            "fax_number": "218-847-6165",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDEBERG",
        "first_name": "BECKY",
        "middle_name": "LEE MCILONIE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-18",
        "last_updated": "2020-04-24",
        "certification_date": "2020-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ND",
            "license": "652",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3090",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BECKY",
            "last_name": "MCILONIE",
            "middle_name": "LEE",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• McKenna Renee Van Winkle
• Hope Louise Bernice Vanburen, MD
• Jeffrey Vance
• Joel Kent Vance, CRNA
• Jennifer Louise Vandal, NP
• Dana Vander Wal
• Scott Allen Vanderhagen, ATC
• Travis Vandewater, MD
• Chad Matthew Vandrovec, M.D.
• Julie Vandrovec, LPCC

• Optometrist in Fargo, ND
• Providers in Fargo, ND by specialty
• Optometrist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2020; 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.