Kellyann Vandendool, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

4301111681 Issued in MI

Practice address

7 Atkinson Dr Ste 200
Ludington, MI 49431-1917

Phone

(231) 843-3717

NPI assigned

Jul 23, 2012

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

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

General Surgery

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Memorial Medical Center of West MichiganGroup PAC ID 3678543659, 62 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Corewell Health Ludington Hospital Hospital, Ludington, MI, CCN 230110

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kvandendool156391@epic00.corewelldirect.org

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.

• Memorial Medical Center of West Michigan

  • General Acute Care Hospital
  • Ludington, MI
  • NPI 1972589489
  Medicare reassignment Care Compare group NPD
• Memorial Medical Center of West Michigan

  • Family Medicine Physician
  • Ludington, MI
  • NPI 1144639360
  NPD
• Grant Medical Center

  • Family Medicine Physician
  • Grant, MI
  • NPI 1437272689
  NPD (past)
• Spectrum Health Primary Care Partners

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1235188673
  NPD (past)

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

• Memorial Medical Center of West Michigan

  • General Acute Care Hospital
  • Ludington, MI
  • NPI 1972589489
  Care Compare affiliation

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

{
    "created_epoch": "1343001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613433600000",
    "number": "1366797615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 ATKINSON DR STE 200",
            "city": "LUDINGTON",
            "state": "MI",
            "postal_code": "494311917",
            "telephone_number": "231-843-3717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDENDOOL",
        "first_name": "KELLYANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-23",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301111681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kvandendool156391@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "7 Atkinson Dr Ste 200",
            "city": "Ludington",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494311917",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "7 Atkinson Dr Ste 200",
            "city": "Ludington",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494311917",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nizar A Umran, M.D.
• Colleen Kay Unsal, IBCLC
• Rebecca Megan Vaara, MOTR/L
• Rosanna Van Wyck, LLPC
• Steven Louis Van Wyck, LMSW
• Zachary Ronald Vanderlaan, MD
• Kirstin Vandevoorde, LLMSW
• Amanda Vanduinen
• Elexus-Ember Aleczandria Vanham, DO
• Marco Antonio Vaquera, CPRM

• Surgery Physician in Ludington, MI
• Providers in Ludington, MI by specialty
• Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2021; 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.