Active NPI
Gerrit Vanderlugt, D.O.
- Family Medicine Physician
- Saint Louis, MI
National Provider Identifier
1477550689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 5101007721
- Practice address
- 224 N Mill St
Saint Louis, MI 48880-1523 - Phone
- (989) 681-3524
- Fax
- (989) 681-2683
- NPI assigned
- Jul 1, 2005
- Last updated
- Jun 26, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | GV007721 | MI | |
| Family Medicine Physician | 207Q00000X | 5101007721 | MI | Primary |
Addresses
Primary practice location
224 N Mill St
Saint Louis, MI 48880-1523
Mailing address
224 N Mill St
Saint Louis, MI 48880-1523
Phone (989) 681-3524
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1020574 | Other | MI | MCLAREN HEALTH PLAN |
| 0852914964 | Other | MI | BCBSM |
| 200000005905 | Other | MI | PHP COMMERCIAL |
| 114893389 | Medicaid | MI | |
| 0983154 | Other | MI | HEALTHPLUS COMMERCIAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| GV007721 | MI | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340668800000",
"number": "1477550689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "224 N MILL ST",
"city": "SAINT LOUIS",
"state": "MI",
"postal_code": "488801523",
"telephone_number": "989-681-3524",
"fax_number": "989-681-2683"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "224 N MILL ST",
"city": "SAINT LOUIS",
"state": "MI",
"postal_code": "488801523",
"telephone_number": "989-681-3524",
"fax_number": "989-681-2683"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDERLUGT",
"first_name": "GERRIT",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-01",
"last_updated": "2012-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MI",
"license": "GV007721",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "5101007721",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCLAREN HEALTH PLAN",
"identifier": "1020574",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "0852914964",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHP COMMERCIAL",
"identifier": "200000005905",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "114893389",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPLUS COMMERCIAL",
"identifier": "0983154",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.