Kristina Rae Vander Mark, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

ME170074 Issued in FL

Practice address

1324 Lakeland Hills Blvd
Lakeland, FL 33805-4543

Phone

(863) 284-6860

NPI assigned

Oct 4, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI, FL2 enrollments

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 2

Specialty

Obstetrics/Gynecology

Education

Wayne State University School of Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lakeland Regional Health Systems IncGroup PAC ID 8325952914, 513 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: kvandermark54291@lrhs.direct-ci.com

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.

• Lakeland Regional Health Systems, Inc.

  • Multi-Specialty Clinic/Center
  • Lakeland, FL
  • NPI 1497748743
  Medicare reassignment Care Compare group NPD
• Mercy Health Partners - Physician Specialist

  • Internal Medicine Physician
  • Muskegon, MI
  • NPI 1922248772
  Medicare reassignment NPD
• HPCN

  • Obstetrics Physician
  • Muskegon, MI
  • NPI 1366527814
  NPD (past)
• HPCN

  • Family Medicine Physician
  • Muskegon, MI
  • NPI 1992749014
  NPD (past)
• Mercy Specialty Services

  • Internal Medicine Physician
  • Muskegon, MI
  • NPI 1629010384

  Obstetrics & Gynecology

  NPD (past)
• OB-GYN Assoc of Marquette PC

  • Obstetrics & Gynecology Physician
  • Marquette, MI
  • NPI 1942394861
  NPD (past)

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739836800000",
    "number": "1366538860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22255 GREENFIELD RD STE 352",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480753712",
            "telephone_number": "248-849-3401",
            "fax_number": "248-849-4106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1324 LAKELAND HILLS BLVD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338054543",
            "telephone_number": "863-284-6860"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6401 Prairie St",
            "address_2": "Suite 2100",
            "address_purpose": "LOCATION",
            "city": "Muskegon",
            "state": "MI",
            "postal_code": "494447840",
            "country_code": "US",
            "telephone_number": "231-727-7939",
            "fax_number": "231-727-7935",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3015 Lakeland Highlands Rd",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338034339",
            "country_code": "US",
            "telephone_number": "863-284-6860",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1637 Shepherd Rd",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338112122",
            "country_code": "US",
            "telephone_number": "863-284-6860",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1525 Lakeland Hills Blvd",
            "address_purpose": "LOCATION",
            "city": "Lakeland",
            "state": "FL",
            "postal_code": "338053203",
            "country_code": "US",
            "telephone_number": "863-284-6860",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "22255 Greenfield Rd Ste 352",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "480753712",
            "country_code": "US",
            "telephone_number": "248-849-3401",
            "fax_number": "248-849-4106",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDER MARK",
        "first_name": "KRISTINA",
        "middle_name": "RAE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "4301076692",
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "MI",
            "license": "4301076692",
            "primary": false
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "MI",
            "license": "4301076692",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME170074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4789630",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cadence Van Hook
• Kelly Van Slyke
• Rene Van Wieringen, PT
• Tyler Vance
• Martha Ann Vanclief, M.D.
• Lisa Marie Vanmatre, PHARMD
• Avito Veloso Vano, PHYSICAL THERAPIST
• Agustin Vanoni, M.D
• William Raymond Vanwye, PT
• Annaliet Vargas Alfonso

• Obstetrics & Gynecology Physician in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Obstetrics & Gynecology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2025; 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.