Frederick Paul Vandusen, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

H67200 Issued in MD

Practice address

119 C N Main Street
Galena, MD 21635

Phone

(410) 648-5150

Fax

(410) 648-5140

NPI assigned

Dec 1, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in WA

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 Osteopathy

State licenses

Practice roles

Locations

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.

• Sea Mar Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Aberdeen, WA
  • NPI 1811051170

  Family Medicine, WA

  Medicare reassignment NPD
• Sea Mar Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Bellevue, WA
  • NPI 1568644714
  NPD
• Sea Mar Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Spanaway, WA
  • NPI 1922624642
  NPD

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332806400000",
    "number": "1619951894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 CN MAIN STREET",
            "city": "GALENA",
            "state": "MD",
            "postal_code": "21635",
            "telephone_number": "410-648-5150",
            "fax_number": "410-648-5140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 C N MAIN STREET",
            "city": "GALENA",
            "state": "MD",
            "postal_code": "21635",
            "telephone_number": "410-648-5150",
            "fax_number": "410-648-5140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDUSEN",
        "first_name": "FREDERICK",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2012-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "DE",
            "license": "C20004063",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "H67200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "442259700",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0001067004",
            "state": "DE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5391600",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INFORMED",
            "identifier": "521116591",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE/MAMSI/OPT CHOICE",
            "identifier": "8177823",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIORITY PARTNERS",
            "identifier": "038396",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Anne La Torre, R.N.,
• Mary Anne la Torre
• Jenna Raschiatore, SLP
• University of Maryland Community Medical Group, Inc.
• University of Maryland Community Medical Group, Inc.

• All providers in Galena, MD
• Family Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2012; 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.