Individual provider Active NPI

James Michael Vandaele, PA-C

  • Physician Assistant
  • Beverly Hills, MI
National Provider Identifier
1396122883
Registry record updated Aug 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601008593 Issued in MI
Practice address
17877 W 14 Mile Rd
Beverly Hills, MI 48025
Phone
(248) 644-3920
Fax
(248) 644-2569
NPI assigned
May 4, 2015
Last updated
Aug 3, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601008593 MI Primary
Surgical Physician Assistant 363AS0400X 018604 NY
Surgical Physician Assistant 363AS0400X 5601008593 MI

Addresses

Primary practice location

17877 W 14 Mile Rd
Beverly Hills, MI 48025

Mailing address

17877 W 14 Mile Rd
Beverly Hills, MI 48025-3127
Phone (248) 644-3920

Other practice location 1

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-2600

Other practice location 2

15855 19 Mile Rd
Clinton Township, MI 48038-3504
Phone (586) 263-2300

Other identifiers 2

IdentifierTypeStateIssuer
5601008593OtherMIPHYSICIAN ASSISTANT LICENSE FOR THE STATE OF MICHIGAN
5315090542OtherMICONTROLLED SUBSTANCE LICENSE

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180426000412 MI Practitioner - Physician Assistant 4688988876 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Mercy College, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

12150 30 Mile Rd
Suite 201
Washington Township, MI 48095-2035
Phone (586) 336-2380

15717 15 Mile Rd
Clinton Township, MI 48035-2101

15855 19 Mile Rd
Clinton Township, MI 48038-3504
Phone (586) 263-2300

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-2600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601008593MIMDPhysician Assistant
018604NYMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Macomb Hospital Corporation CurrentSince Aug 1, 2023 Accepting new patients
Henry Ford Macomb Hospital Corporation CurrentSince Aug 1, 2023 Accepting new patients
Michigan Orthopaedic Surgeons, PLLC CurrentSince Apr 30, 2018 Accepting new patients
Henry Ford Health System Physician Assistant CurrentSince Aug 1, 2023 Accepting new patients
Henry Ford Health System CurrentSince Aug 1, 2023 Accepting new patients

Locations

17877 W 14 Mile Rd
Beverly Hills, MI 48025
Phone (248) 644-3920

15717 15 Mile Rd
Clinton Twp, MI 48035
Phone (586) 285-3800

15855 19 Mile Rd
Clinton Twp, MI 48038
Phone (586) 263-2300

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

Interoperability endpoints

  • Direct secure messaging: jvandaele883606@direct.hfhs.org

Organizations & group practices 5

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 3

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": "1430697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691020800000",
    "number": "1396122883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17877 W 14 MILE RD",
            "city": "BEVERLY HILLS",
            "state": "MI",
            "postal_code": "480253127",
            "telephone_number": "248-644-3920",
            "fax_number": "248-644-2569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17877 W 14 MILE RD",
            "city": "BEVERLY HILLS",
            "state": "MI",
            "postal_code": "48025",
            "telephone_number": "248-644-3920",
            "fax_number": "248-644-2569"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2799 W Grand Blvd",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482022608",
            "country_code": "US",
            "telephone_number": "313-916-2600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15855 19 Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Clinton Township",
            "state": "MI",
            "postal_code": "480383504",
            "country_code": "US",
            "telephone_number": "586-263-2300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDAELE",
        "first_name": "JAMES",
        "middle_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-04",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601008593",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "018604",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "5601008593",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT LICENSE FOR THE STATE OF MICHIGAN",
            "identifier": "5601008593",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTROLLED SUBSTANCE LICENSE",
            "identifier": "5315090542",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly Hills, MI

Sources for this page

Verify at the official NPI Registry.