NPIMap

Individual provider Active NPI

Douglas R Vanderjagt, D.O.

  • Internal Medicine Physician
  • Williamston, MI
National Provider Identifier
1730121880
Registry record updated Mar 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5101013545 Issued in MI
Practice address
839 S Putnam St
Williamston, MI 48895-1623
Phone
(517) 655-3515
Fax
(855) 476-0189
NPI assigned
Jun 12, 2006
Last updated
Mar 24, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 5101013545 MI Primary

Addresses

Primary practice location

839 S Putnam St
Williamston, MI 48895-1623

Mailing address

3955 Patient Care Dr
Lansing, MI 48911-4299
Phone (517) 374-7600

Other practice location 1

3955 Patient Care Dr Ste A
Lansing, MI 48911-4271
Phone (517) 374-7600

Other identifiers 11

IdentifierTypeStateIssuer
110205373OtherMIRAILROAD MEDICARE
1000922OtherMIMCLAREN HEALTH PLAN-COMMERCIAL
1000922OtherMIMCLAREN HEALTH PLAN-MEDICAID
200000000943OtherMIPHP FAMILYCARE
1153302705OtherMIBCBS/BCN
1000922OtherMIMCLAREN HEALTH ADVANTAGE
4218345MedicaidMI
4835895MedicaidMI
0M21440018OtherMIMEDICARE ADVANTAGE
7256209OtherMIAETNA
200000000943OtherMIPHP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20040406001309 MI Practitioner - Internal Medicine 7810809555 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Michigan State University College of Osteopathic Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Capital Internal Medicine Associates P.C.Group PAC ID 8022097963, 64 clinicians

Practice addresses (Care Compare)

839 S Putnam St
Williamston Primary Care
Williamston, MI 48895-1623
Phone (517) 655-3515

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101013545MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Capital Internal Medicine Associates P.C. Internal Medicine CurrentSince Mar 29, 2019 Accepting new patients

Locations

3955 Patient Care Dr
Lansing, MI 48911
Phone (517) 374-7600

3955 Patient Care Dr
Ste A
Lansing, MI 48911
Phone (517) 374-7600

401 W Greenlawn Ave
Lansing, MI 48910
Phone (517) 334-2286

839 S Putnam St
Williamston, MI 48895
Phone (517) 655-3515

Interoperability endpoints

  • Direct secure messaging: douglas.vanderjagt@cimamed.eclinicaldirectplus.com

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.

Hospital & facility affiliations 10

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": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742774400000",
    "number": "1730121880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3955 PATIENT CARE DR",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489114299",
            "telephone_number": "517-374-7600",
            "fax_number": "885-480-9150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "839 S PUTNAM ST",
            "city": "WILLIAMSTON",
            "state": "MI",
            "postal_code": "488951623",
            "telephone_number": "517-655-3515",
            "fax_number": "855-476-0189"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3955 Patient Care Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "MI",
            "postal_code": "489114271",
            "country_code": "US",
            "telephone_number": "517-374-7600",
            "fax_number": "885-480-9150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDERJAGT",
        "first_name": "DOUGLAS",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101013545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110205373",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN HEALTH PLAN-COMMERCIAL",
            "identifier": "1000922",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN HEALTH PLAN-MEDICAID",
            "identifier": "1000922",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP FAMILYCARE",
            "identifier": "200000000943",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS/BCN",
            "identifier": "1153302705",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCLAREN HEALTH ADVANTAGE",
            "identifier": "1000922",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4218345",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4835895",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ADVANTAGE",
            "identifier": "0M21440018",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7256209",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP",
            "identifier": "200000000943",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamston, MI

Sources for this page

Verify at the official NPI Registry.