Active NPI
Andrea Leigh Vandam, PA
- Physician Assistant
- Sebring, FL
National Provider Identifier
1639453640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9106204
- Practice address
- 3201 Medical Way
Suite 101
Sebring, FL 33870-5412 - Phone
- (863) 382-0770
- Fax
- (863) 471-9968
- NPI assigned
- Oct 10, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9106204 | FL | Primary |
Addresses
Primary practice location
3201 Medical Way
Suite 101
Sebring, FL 33870-5412
Mailing address
3201 Medical Way
Suite 101
Sebring, FL 33870-5412
Phone (863) 382-0770
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PAX00009111 | Other | FL | PRESCRIBING LICENSE |
| 004133400 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9106204 | FL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pro Star Pediatrics | Past | Accepting new patients | |
| Privia Medical Group Florida, LLC | Past | Accepting new patients |
Interoperability endpoints
- andrea.vandam.1@8042.direct.athenahealth.com
- a.vandam@rdvpediatrics.directbygreenway.com
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.
-
- General Practice Physician
- Indialantic, FL
- NPI 1700649043
-
- Pediatric Adolescent Medicine Physician
- Orlando, FL
- NPI 1972679223
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323648000000",
"number": "1639453640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3201 MEDICAL WAY",
"address_2": "SUITE 101",
"city": "SEBRING",
"state": "FL",
"postal_code": "338705412",
"telephone_number": "863-382-0770",
"fax_number": "863-471-9968"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3201 MEDICAL WAY",
"address_2": "SUITE 101",
"city": "SEBRING",
"state": "FL",
"postal_code": "338705412",
"telephone_number": "863-382-0770",
"fax_number": "863-471-9968"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDAM",
"first_name": "ANDREA",
"middle_name": "LEIGH",
"name_prefix": "Ms.",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-10",
"last_updated": "2011-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9106204",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRESCRIBING LICENSE",
"identifier": "PAX00009111",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004133400",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sebring, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.