Mark Thomas Vandenberg, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

25285 Issued in IA

Practice address

1215 Duff Ave
Ames, IA 50010-3014

Phone

(515) 239-4725

Fax

(515) 956-4130

NPI assigned

Nov 15, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Boone County Hospital

  • Critical Access Hospital
  • Boone, IA
  • NPI 1467434225
  NPD (past)

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

{
    "created_epoch": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1669454807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 DUFF AVE",
            "city": "AMES",
            "state": "IA",
            "postal_code": "500103014",
            "telephone_number": "515-239-4725",
            "fax_number": "515-956-4130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 DUFF AVE",
            "city": "AMES",
            "state": "IA",
            "postal_code": "500103014",
            "telephone_number": "515-239-4725",
            "fax_number": "515-956-4130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDENBERG",
        "first_name": "MARK",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-15",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IA",
            "license": "25285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0202259",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kylee Jean Valencia
• Shannon Alexandra Van Beest
• Amanda Van Wyk, AGNP-C
• Amanda J Vanden Wynboom, ARNP
• Taylor Haazen Gerardus Vanden Wynboom, D.C.
• Jacobus Vandeneijkhoff
• Colton Vander Berg, DPT
• Joshua Vander Zwaag, LISW
• Sarah J. Vanhauen, DO
• Kathryn Ann Vannoy, MS, RDN, LD

• Surgery Physician in Ames, IA
• Providers in Ames, IA by specialty
• Surgery Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; 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.