Ruth Jean Vandenberg, P.A.-C.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601004042 Issued in MI

Practice address

1330 Plainfield Ave NE
Grand Rapids, MI 49505-4913

Phone

(616) 776-0814

Fax

(616) 776-9956

NPI assigned

May 23, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Creston Medical Center, PLLC

  dba Creston Medical Center

  • Health Service Clinic/Center
  • Grand Rapids, MI
  • NPI 1154583078
  NPD (past)
• Pine Rest Christian Mental Health Services

  • Physician Assistant
  • Grand Rapids, MI
  • NPI 1376554519
  NPD (past)
• Pine Rest Christian Mental Health Services

  • Professional Counselor
  • Grand Rapids, MI
  • NPI 1386015683
  NPD (past)

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679783120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2564",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495012564",
            "telephone_number": "646-776-0814",
            "fax_number": "616-776-9956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 PLAINFIELD AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495054913",
            "telephone_number": "616-776-0814",
            "fax_number": "616-776-9956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDENBERG",
        "first_name": "RUTH",
        "middle_name": "JEAN",
        "name_prefix": "Miss",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremy Browning Vandenberg, M.D.
• Jessica Vandenberg
• Jonathan Christian Vandenberg, D.O
• Michael Vandenberg, DPT
• Michelle Vandenberg, LLMSW; BLS
• Samantha Vandenberg, FNP
• Stacey Lynn Vandenberg, MA, LPC, NCC, CAADC
• William Christian Vandenberg, M.D.
• Kylie Jay Vandenberge
• Stacey Michelle Vandenberge, OTR

• Physician Assistant in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.