NPIMap

Individual provider Active NPI

Kristin M Vandomelen, M.D.

  • Internal Medicine Physician
  • Bend, OR
National Provider Identifier
1710117122
Registry record updated Apr 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD157351 Issued in OR
Practice address
2160 NE Williamson CT
Bend, OR 97701-3760
Phone
(541) 389-1118
NPI assigned
Jul 20, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD60284548 WA
Internal Medicine Physician 207R00000X MD157351 OR Primary

Addresses

Primary practice location

2160 NE Williamson CT
Bend, OR 97701-3760

Mailing address

2160 NE Williamson CT
Bend, OR 97701-3760
Phone (541) 389-1118

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140527000515 OR Practitioner - Internal Medicine 3577716919 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Oregon Health Sciences University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fall Creek Internal Medicine, LLPGroup PAC ID 7810980497, 5 clinicians

Practice addresses (Care Compare)

2160 NE Williamsom CT
Bend, OR 97701-3760
Phone (541) 389-1118

Hospital & facility affiliations

  • St. Charles Home Health Services Home health agency, Bend, OR, CCN 387026
  • St Charles Medical Center - Bend Hospital, Bend, OR, CCN 380047
  • St Charles Medical Center Prineville Hospital, Prineville, OR, CCN 381313
  • St Charles Madras Hospital, Madras, OR, CCN 381324

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD60284548WAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fall Creek Internal Medicine, LLP Internal Medicine CurrentSince Feb 15, 2015 Accepting new patients
Bend Memorial Clinic PC Internal Medicine PastSince Feb 15, 2015 Accepting new patients

Locations

2160 NE Williamson Ct
Bend, OR 97701
Phone (541) 389-1118

Interoperability endpoints

  • Direct secure messaging: kvandomelen24622@coipa.gardenplot.direct-ci.com
  • FHIR API: https://epicproxy.et4001.epichosted.com/APIProxyPRD/FCIM/api/FHIR/R4

Organizations & group practices 3

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1248048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460592000000",
    "number": "1710117122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 NE WILLIAMSON CT",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977013760",
            "telephone_number": "541-389-1118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 NE WILLIAMSON CT",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977013760",
            "telephone_number": "541-389-1118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDOMELEN",
        "first_name": "KRISTIN",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-20",
        "last_updated": "2016-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD60284548",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD157351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.