Peter S Vandemark, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301038966 Issued in MI

Practice address

1019 Campus Drive
Big Rapids, MI 49307

Phone

(231) 591-5961

Fax

(231) 591-5970

NPI assigned

Nov 7, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484784000000",
    "number": "1437130606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 CAMPUS DRIVE",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "49307",
            "telephone_number": "231-591-5961",
            "fax_number": "231-591-5970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019 CAMPUS DRIVE",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "49307",
            "telephone_number": "231-591-5961",
            "fax_number": "231-591-5970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDEMARK",
        "first_name": "PETER",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-07",
        "last_updated": "2017-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301038966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0540004",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA RAILROAD MR",
            "identifier": "110154022",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3377875",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Twin Family Medical PC
• Nicole Urbon, AGNP-C
• Kevin Daniel Vaillancourt, LLPC
• Keith Valkner, LMSW
• John Randall Vance, OD
• Scott D Vander Hill, M.D.
• Valerie Joy Vandertol
• Brianna Vanhouten
• Abby Kate Vanotteren-Smith, PA-C
• Jessica Marie Vantroostenberghe, MAT, ATC

• Internal Medicine Physician in Big Rapids, MI
• Providers in Big Rapids, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.