Erica Ann Vandervort, COTA

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

License

057.004570 Issued in IL

Practice address

7222 W Cermak Rd
Ste 500
Riverside, IL 60546-1422

Phone

(708) 442-0023

NPI assigned

Aug 8, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Erica Ann Hurst Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Smart Moves Pediatrics

  • Developmental Disabilities Clinic/Center
  • North Riverside, IL
  • NPI 1750552972
  NPD (past)

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

{
    "created_epoch": "1470614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470614400000",
    "number": "1578017471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7222 W CERMAK RD",
            "address_2": "STE 500",
            "city": "RIVERSIDE",
            "state": "IL",
            "postal_code": "605461422",
            "telephone_number": "708-442-0023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7222 W CERMAK RD",
            "address_2": "STE 500",
            "city": "RIVERSIDE",
            "state": "IL",
            "postal_code": "605461422",
            "telephone_number": "708-442-0023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERVORT",
        "first_name": "ERICA",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "COTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-08",
        "last_updated": "2016-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "IL",
            "license": "057.004570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ERICA",
            "last_name": "HURST",
            "middle_name": "ANN",
            "prefix": "MRS.",
            "credential": "COTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Anna Tess, ED.D
• Edward Tong, MD
• Treetop Therapy
• Emil Jay Vancura, M.D.
• Tonya Vander, LSW
• Staci Michelle Vetrovsky, RD, LDN
• VHS of Illinois Inc
• Village of Riverside
• Diane Louise Wallendjack, EDD, NCSP
• Minetta Wallingford, OTR/L

• Early Intervention Provider Agency in Riverside, IL
• Providers in Riverside, IL by specialty
• Early Intervention Provider Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2016; 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.