Gene Allen Vandervort Jr., D.D.S./M.D.

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

0101102662 Issued in VA

Practice address

44340 Premier Plaza
Suite 100
Ashburn, VA 20147-5074

Phone

(703) 729-8700

Fax

(703) 729-5300

NPI assigned

Feb 21, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Sep 24, 2013 through Sep 24, 2027

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.

• Bluhm, Dorsch and Vandervort, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Ashburn, VA
  • NPI 1265578413
  NPD (past)

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247097600000",
    "number": "1679548010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44340 PREMIER PLAZA",
            "address_2": "SUITE 100",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201475074",
            "telephone_number": "703-729-8700",
            "fax_number": "703-729-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44340 PREMIER PLAZA",
            "address_2": "SUITE 100",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201475074",
            "telephone_number": "703-729-8700",
            "fax_number": "703-729-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERVORT",
        "first_name": "GENE",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S./M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2009-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "VA",
            "license": "0101102662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Valderrama
• Valerie V Woo DMD PC
• Neelima Vallepalli
• Cassidy Van Bevers, DC
• Howard Foard Van Horn III, PHARM.D, M.B.A.
• Thomas A Vandruff, NP
• Jesse B Vanous, MSW
• Varam LLC
• Ariana Varela
• Venkateswar R Veerapalli, MD

• Oral & Maxillofacial Surgery (D.M.D.) in Ashburn, VA
• Providers in Ashburn, VA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2009; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.