Active NPI
Kent A Vandenberg, MD
- Family Medicine Physician
- Indianapolis, IN
National Provider Identifier
1689667982
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01041231
- Practice address
- 9011 N Meridian St
Suite 110
Indianapolis, IN 46260-5378 - Phone
- (317) 581-8888
- Fax
- (317) 705-7178
- NPI assigned
- Aug 23, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01041231 | IN | Primary |
Addresses
Primary practice location
9011 N Meridian St
Suite 110
Indianapolis, IN 46260-5378
Mailing address
9011 N Meridian St
Suite 110
Indianapolis, IN 46260-5378
Phone (317) 581-8888
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01041231 | IN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Morning Star Medical Group | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Carmel, IN
- NPI 1528267218
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689667982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9011 N MERIDIAN ST",
"address_2": "SUITE 110",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462605378",
"telephone_number": "317-581-8888",
"fax_number": "317-705-7178"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9011 N MERIDIAN ST",
"address_2": "SUITE 110",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462605378",
"telephone_number": "317-581-8888",
"fax_number": "317-705-7178"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDENBERG",
"first_name": "KENT",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01041231",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- 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.