Individual provider Active NPI

Tammy Vanderstelt

  • Nurse Practitioner
  • Kalamazoo, MI
National Provider Identifier
1588775365
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704196839 Issued in MI
Practice address
1701 Gull Rd
Kalamazoo, MI 49048-1609
Phone
(269) 226-5290
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704196839 MI Primary

Addresses

Primary practice location

1701 Gull Rd
Kalamazoo, MI 49048-1609

Mailing address

5943 Stadium Dr
Suite 3
Kalamazoo, MI 49009-3016

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051114000656 MI Practitioner - Nurse Practitioner 0840219408 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ascension Medical Group PromedGroup PAC ID 7315856077, 255 clinicians

Practice addresses (Care Compare)

7901 Angling Rd
Portage, MI 49024-0714

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704196839MIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Promed Healthcare CurrentSince May 1, 2009 Accepting new patients
Ascension Medical Group Promed CurrentSince May 1, 2009 Accepting new patients

Locations

1701 Gull Rd
Kalamazoo, MI 49048
Phone (269) 226-2550

5943 Stadium Dr
Ste 3
Kalamazoo, MI 49009
Phone (269) 226-8315

1521 Gull Rd
#146E
Kalamazoo, MI 49048

7901 Angling Rd
Portage, MI 49024
Phone (269) 324-8405

Organizations & group practices 2

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 3

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1588775365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5943 STADIUM DR",
            "address_2": "SUITE 3",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490093016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 GULL RD",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490481609",
            "telephone_number": "269-226-5290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERSTELT",
        "first_name": "TAMMY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704196839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.