NPIMap

Individual provider Active NPI

Timothy Vanadurongvan, M.D.

  • Urology Physician
  • Grand Junction, CO
National Provider Identifier
1508284506
Registry record updated Feb 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
DR.0063676 Issued in CO
Practice address
2373 G Rd Ste 200
Grand Junction, CO 81505-1006
Phone
(970) 243-0900
Fax
(970) 245-8369
NPI assigned
Apr 7, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X DR.0063676 CO Primary

Addresses

Primary practice location

2373 G Rd Ste 200
Grand Junction, CO 81505-1006

Mailing address

Urological Associates of Western Colorado a Div of Csa
2373 G Road Suite 200
Grand Junction, CO 81505-1006
Phone (970) 243-3061

Other practice location 1

715 Ballard Ct
Vermillion, SD 57069-7029
Phone (612) 385-2745

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200514002337 CO Practitioner - Urology 6305142019 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Sanford School of Medicine of University of South Dakota, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Delta County Memorial HospitalGroup PAC ID 1850200601, 107 clinicians
Colorado Surgical Affiliates LLCGroup PAC ID 5496034068, 52 clinicians

Practice addresses (Care Compare)

1501 E 3Rd St
Urology
Delta, CO 81416-2815
Phone (970) 399-2890

2373 G Rd
Suite 200
Grand Junction, CO 81505-1006
Phone (970) 243-3061

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Delta County Memorial Hospital CurrentSince Sep 1, 2020 Accepting new patients
Colorado Surgical Affiliates, LLC Urology CurrentSince Jul 1, 2020 Accepting new patients
Delta County Memorial Hospital CurrentSince Sep 1, 2020 Accepting new patients
Colorado Surgical Affiliates, LLC Urology CurrentSince Jul 1, 2020 Accepting new patients
Delta County Memorial Hospital Urology Past Accepting new patients

Locations

1450 Burgess St
Delta, CO 81416
Phone (970) 874-7668

1501 E 3rd St
Delta, CO 81416
Phone (970) 874-2470

1501 E 3rd St
Bldg C
Delta, CO 81416

2373 G Rd
Ste 200
Grand Junction, CO 81505
Phone (970) 241-4444

2440 N 11th St
Grand Junction, CO 81501
Phone (970) 243-0900

Interoperability endpoints

  • Direct secure messaging: tvanadurongvan@csa.emadirect.md
  • Direct secure messaging: timothy.vanadurongvan.1@12539.direct.athenahealth.com

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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1396828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613001600000",
    "number": "1508284506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UROLOGICAL ASSOCIATES OF WESTERN COLORADO A DIV OF CSA",
            "address_2": "2373 G ROAD SUITE 200",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815051006",
            "telephone_number": "970-243-3061",
            "fax_number": "970-245-8269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2373 G RD STE 200",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815051006",
            "telephone_number": "970-243-0900",
            "fax_number": "970-245-8369"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "715 Ballard Ct",
            "address_purpose": "LOCATION",
            "city": "Vermillion",
            "state": "SD",
            "postal_code": "570697029",
            "country_code": "US",
            "telephone_number": "612-385-2745",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANADURONGVAN",
        "first_name": "TIMOTHY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-07",
        "last_updated": "2021-02-11",
        "certification_date": "2021-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CO",
            "license": "DR.0063676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Junction, CO

Sources for this page

Verify at the official NPI Registry.