NPIMap

Individual provider Active NPI

Jennifer Anne Vandenburgh, PA

  • Physician Assistant
  • Clifton Park, NY
National Provider Identifier
1548754468
Registry record updated Jun 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
022092 Issued in NY
Practice address
939 Route 146 Ste 700
Clifton Park, NY 12065-3662
Phone
(518) 383-0891
Fax
(518) 383-1662
NPI assigned
Jun 15, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 022092 NY Primary

Addresses

Primary practice location

939 Route 146 Ste 700
Clifton Park, NY 12065-3662

Mailing address

711 Troy Schenectady Rd Ste 203
Latham, NY 12110-2461
Phone (518) 782-3700

Other identifiers 1

IdentifierTypeStateIssuer
05205601MedicaidNY

Other names 1

  • Jennifer Hale Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20180727000328 NY Practitioner - Physician Assistant 4284981812 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Care Physicians PLLCGroup PAC ID 8022904473, 361 clinicians

Practice addresses (Care Compare)

711 Troy Schenectady Rd
Latham, NY 12110-2461

989 Route 146
Suite 200
Clifton Park, NY 12065-3647
Phone (518) 383-0891

Hospital & facility affiliations

  • Samaritan Hospital of Troy, New York Hospital, Troy, NY, CCN 330180
  • Saratoga Hospital Hospital, Saratoga Springs, NY, CCN 330222

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Physicians, PC Past Accepting new patients
Community Care Physicians, PC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jenniferhale@ccp.allscriptsdirect.net

Organizations & group practices 3

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 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1529020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655683200000",
    "number": "1548754468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 TROY SCHENECTADY RD STE 203",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102461",
            "telephone_number": "518-782-3700",
            "fax_number": "518-782-3799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "939 ROUTE 146 STE 700",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120653662",
            "telephone_number": "518-383-0891",
            "fax_number": "518-383-1662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDENBURGH",
        "first_name": "JENNIFER",
        "middle_name": "ANNE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-15",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "022092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05205601",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "HALE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Clifton Park, NY

Sources for this page

Verify at the official NPI Registry.