Ellen Blair Vandenberg, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901005363 Issued in MI

Practice address

10701 East Blvd
Cleveland, OH 44106-1702

Phone

(216) 791-3800

NPI assigned

Jun 1, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI, OH2 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

Ohio State University - College of Optometry, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye Care Associates of Marietta LLCGroup PAC ID 6608158696, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Eye Care Associates of Marietta LLC

  • Optometrist
  • Marietta, OH
  • NPI 1033296868
  Medicare reassignment Care Compare group NPD
• Eye Care of McConnelsville LLC

  • Optometrist
  • McConnelsville, OH
  • NPI 1225115058
  Medicare reassignment NPD
• Blue Sky Vision Eye Care, P.C

  • Ophthalmology Physician
  • Grand Rapids, MI
  • NPI 1801977202

  Optometrist

  Medicare reassignment NPD
• Blue Sky Vision Eye Care, PC

  • Ophthalmology Physician
  • Dearborn, MI
  • NPI 1316675598
  NPD
• Walker Surgical Center LLC

  • Ambulatory Surgical Clinic/Center
  • Walker, MI
  • NPI 1679612253
  NPD (past)

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

{
    "created_epoch": "1527811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566259200000",
    "number": "1336631647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 304",
            "city": "LOWELL",
            "state": "OH",
            "postal_code": "457440304",
            "telephone_number": "740-516-4216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10701 EAST BLVD",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441061702",
            "telephone_number": "216-791-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDENBERG",
        "first_name": "ELLEN",
        "middle_name": "BLAIR",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-01",
        "last_updated": "2019-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901005363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olyria A Vance
• Rachael Vance, RBT
• William Vance
• Rachel Vancoillie, DO
• Judy Faye Vancuren, APRN
• Anne Vanderbilt, CNS, CNP
• Ashley Houston Vandercar, M.D., J.D.
• Tyler Scott Vanderhoof, MD
• Kathryn B Vanderplough
• Syarrah Vanderwall

• Optometrist in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2019; 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.