Evan Reid Vandenbosch, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601007644 Issued in MI

Practice address

36622 5 Mile Rd
Suite 101
Livonia, MI 48154-1900

Phone

(734) 542-0200

NPI assigned

Dec 30, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mendelson Orthopedics PCGroup PAC ID 8426008368, 69 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Joe Mercy Hospital System Livonia Hospital, Livonia, MI, CCN 230002

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: evandenbosch44908@direct.trinity-health.org
• Direct secure messaging: evandenbosch1156356@direct.hfhs.org
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Mendelson Orthopedics PC

  • Orthopaedic Surgery Physician
  • Sterling Heights, MI
  • NPI 1720395205
  Medicare reassignment Care Compare group
• Mendelson Orthopedics PC

  • Orthopedic Physical Therapist
  • Warren, MI
  • NPI 1023325438
  NPD
• Mendelson Orthopedics PC

  • Interventional Pain Medicine Physician
  • Warren, MI
  • NPI 1700239415
  NPD
• Mendelson Orthopedics PC

  • Orthopaedic Surgery Physician
  • Livonia, MI
  • NPI 1720153463
  NPD (past)

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

• St Mary Mercy Hospital

  • General Acute Care Hospital
  • Livonia, MI
  • NPI 1790706901
  Care Compare affiliation

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

{
    "created_epoch": "1451433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1710342134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36622 5 MILE RD",
            "address_2": "SUITE 101",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481541900",
            "telephone_number": "734-542-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36622 5 MILE RD",
            "address_2": "SUITE 101",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481541900",
            "telephone_number": "734-542-0200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "35735 Mound Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Sterling Heights",
            "state": "MI",
            "postal_code": "483104728",
            "country_code": "US",
            "telephone_number": "586-261-1960",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDENBOSCH",
        "first_name": "EVAN",
        "middle_name": "REID",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-12-30",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "5601007644",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassandra Anne Valeri, OTRL
• Madhu Leena Vallala, RPT
• McKenzie Van Assche, MA
• Joann Van Oast, P.A.
• Lauren Alice Vande Laare
• Da'Myra Armanti Vanderroes
• Carol Vandyke
• Allison Vanhouten
• Jaya Vankayalapati, M.D.
• Tiffany Vanner

• Physician Assistant in Livonia, MI
• Providers in Livonia, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; 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.
• 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.