Lucas Jacob Vanderlaan, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501018017 Issued in MI

Practice address

28933 Woodward Ave
Berkley, MI 48072-0923

Phone

(248) 414-7592

Fax

(248) 414-7661

NPI assigned

Jan 23, 2017

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 names 1

• Lucas Jacob Van Der Laan Other name

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orthosport Physical Therapy and Athletic Rehabilitation IncGroup PAC ID 0547203952, 5 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

90.95 of 100Reported as group

Quality

94.34

Improvement activities

40

Cost

77.4

Medicare enrollment (NPD)

Enrolled

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.

• Orthosport Physical Therapy and Athletic Rehabilitation Inc.

  • Orthopedic Physical Therapist
  • Petoskey, MI
  • NPI 1710995246
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1485129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485129600000",
    "number": "1679010177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28933 WOODWARD AVE",
            "city": "BERKLEY",
            "state": "MI",
            "postal_code": "480720923",
            "telephone_number": "248-414-7592",
            "fax_number": "248-414-7661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28933 WOODWARD AVE",
            "city": "BERKLEY",
            "state": "MI",
            "postal_code": "480720923",
            "telephone_number": "248-414-7592",
            "fax_number": "248-414-7661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERLAAN",
        "first_name": "LUCAS",
        "middle_name": "JACOB",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-23",
        "last_updated": "2017-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501018017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LUCAS",
            "last_name": "VAN DER LAAN",
            "middle_name": "JACOB",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ann Tonkin, PT, ATC
• Emily Tripp, DC
• Mackenzie May Tuohy
• Scott Phillip Turner
• Hillary Tye
• Susan Varady, LMSW, ACSW
• Vickie Novell, P.L.L.C.
• Erica Volpe, RDH
• Victoria Therese Voros, PA-C
• Rohit Vyas

• Physical Therapist in Berkley, MI
• Providers in Berkley, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.