Timothy Gerard Vandenboom II, M.D.

Primary specialty

Dermatopathology PhysicianTaxonomy code 207ND0900X

License

4301114577 Issued in MI

Practice address

5301 E Huron River Dr
Ypsilanti, MI 48197-1051

Phone

(734) 712-3161

NPI assigned

Mar 29, 2012

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

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pathology

Education

Wayne State University School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Trinity Health Ann Arbor Hospital Hospital, Ann Arbor, MI, CCN 230156
• St Joe Mercy Hospital System Livonia Hospital, Livonia, MI, CCN 230002
• University of Michigan Health System Hospital, Ann Arbor, MI, CCN 230046
• Trinity Health Oakland Hospital Hospital, Pontiac, MI, CCN 230029
• Trinity Health Livingston Hospital Hospital, Howell, MI, CCN 230069

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Iha Health Services Corporation

  dba IHA Canton Obstetrics and Gynecology

  • Obstetrics & Gynecology Physician
  • Canton, MI
  • NPI 1457408965
  Medicare reassignment Care Compare group NPD
• Pinkus Dermatopathology Laboratory, PC

  • Clinical Medical Laboratory
  • Monroe, MI
  • NPI 1346223377

  Anatomic Pathology & Clinical Pathology

  Medicare reassignment NPD
• Consultants in Laboratory Medicine of Greater Toledo

  • Anatomic Pathology & Clinical Pathology Physician
  • Toledo, OH
  • NPI 1982673372

  MI

  Medicare reassignment NPD
• Iha Health Service Corporation

  dba Trinity Health IHA Medical Group OB/GYN Float

  • Obstetrics & Gynecology Physician
  • Ypsilanti, MI
  • NPI 1831053701
  NPD
• Iha Health Services Corporation

  • Clinical Pathology/Laboratory Medicine Physician
  • Ann Arbor, MI
  • NPI 1760723340
  NPD

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

• Regents of the University of Michigan

  dba University of Michigan Health System

  • General Acute Care Hospital
  • Ann Arbor, MI
  • NPI 1003878539
  Care Compare affiliation
• Saint Joseph Mercy Livingston Hospital

  • General Acute Care Hospital
  • Brighton, MI
  • NPI 1093748642
  Care Compare affiliation
• St Joseph Mercy Hospital

  dba Trinity Heath Ann Arbor Hospital

  • General Acute Care Hospital
  • Ypsilanti, MI
  • NPI 1780658443
  Care Compare affiliation
• St Joseph Mercy Hospital-SMHC

  dba St Joseph Mercy Oakland

  • General Acute Care Hospital
  • Pontiac, MI
  • NPI 1053356352
  Care Compare affiliation
• St Mary Mercy Hospital

  • General Acute Care Hospital
  • Livonia, MI
  • NPI 1790706901
  Care Compare affiliation

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

{
    "created_epoch": "1332979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619395200000",
    "number": "1629344189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 FRANK LLOYD WRIGHT DR LBBY J2000",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481059484",
            "telephone_number": "734-747-6766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 E HURON RIVER DR",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971051",
            "telephone_number": "734-712-3161"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "676 N Saint Clair St",
            "address_2": "Suite 1765",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606112927",
            "country_code": "US",
            "telephone_number": "312-695-1413",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1314 N Macomb St",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "MI",
            "postal_code": "481623131",
            "country_code": "US",
            "telephone_number": "800-746-5870",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDENBOOM",
        "first_name": "TIMOTHY",
        "middle_name": "GERARD",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-29",
        "last_updated": "2021-04-26",
        "certification_date": "2021-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IL",
            "license": "125062313",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "MI",
            "license": "4301114577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy A Van Alstine, D.D.S.
• Kelley Nicole Van Gemert, LMSW
• Elle Marie Van Overmeer
• Jennifer Vanalsburg
• Anne Kirsten Vanden Belt, M.D.
• Veronica Vanderwill
• Tara Vandewarker, PA-C
• Kimberly Ann Vandewege, RDN
• Samantha Vanduser, BCBA, LBA
• David Vanoverbeke, MS, PA-C

• Dermatopathology Physician in Ypsilanti, MI
• Providers in Ypsilanti, MI by specialty
• Dermatopathology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.