Mark P Vanderburgh, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD287521 Issued in OR

Practice address

3494 Liberty Rd S
Salem, OR 97302-4607

Phone

(503) 399-2424

Fax

(503) 375-7429

NPI assigned

Jun 9, 2006

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

Enrolled in OR

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

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": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274918400000",
    "number": "1497796866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8100",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973030900",
            "telephone_number": "503-399-2424",
            "fax_number": "503-375-7429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3494 LIBERTY RD S",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024607",
            "telephone_number": "503-399-2424",
            "fax_number": "503-375-7429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERBURGH",
        "first_name": "MARK",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2010-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD287521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287521",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD GROUP",
            "identifier": "CS4159",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080170917",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Vance, OTR
• Amy Michelle Vancleave, MSW
• George Vancura
• Anneke Vander Haak
• Regina E Vander, LCSW
• Nicole Maria Vanderheyden, M.D, PHD
• Jacob Vanderstarre, M.D.
• Penny L Vanderveer, MD
• Curtis V Vanderwerff, MA
• Karen Marie Vanderwerff, M.S.

• Family Medicine Physician in Salem, OR
• Providers in Salem, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.