NPIMap

Individual provider Active NPI

Charles Jay Vandenberg IV, D.O.

  • Internal Medicine Physician
  • Manistee, MI
National Provider Identifier
1750638516
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5101021764 Issued in MI
Practice address
1293 E Parkdale Ave
Manistee, MI 49660-8904
Phone
(231) 398-1840
NPI assigned
Aug 12, 2012
Last updated
Sep 16, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

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 2012020880 MO
Internal Medicine Physician 207R00000X 5101021764 MI Primary

Addresses

Primary practice location

1293 E Parkdale Ave
Manistee, MI 49660-8904

Mailing address

1391 E Parkdale Ave
Manistee, MI 49660-9352
Phone (231) 398-1760

Other practice location 1

1391 E Parkdale Ave
Manistee, MI 49660-9352
Phone (231) 398-1760

Other practice location 2

5085 Anna Dr Ste B&c
Traverse City, MI 49684-7475
Phone (231) 935-5900

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address charles.vandenberg@wsmcps.eclinicaldirectplus.com

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
I20151020003017 MI Practitioner - Internal Medicine 6305155029 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1465 E Parkdale Ave
West Shore Medical Center
Manistee, MI 49660-9709
Phone (231) 723-3501

3021 Schoedel Rd
Manistee, MI 49660-9753
Phone (231) 397-9229

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2012020880MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Medical Center Current Accepting new patients
Birch Shore Primary Care PLLC Internal Medicine CurrentSince Jun 1, 2026 Accepting new patients
Munson Healthcare Manistee Hospital Current Accepting new patients
Munson Medical Center Internal Medicine CurrentSince Sep 30, 2024 Accepting new patients
Munson Healthcare Manistee Hospital CurrentSince Sep 30, 2015 Accepting new patients
Munson Healthcare Manistee Hospital Past Accepting new patients

Locations

2513 Momentum Pl
Chicago, IL 60689
Phone (231) 935-8031

1293 E Parkdale Ave
Manistee, MI 49660
Phone (231) 398-1735

1293 E Parkdale Ave
Ste 2
Manistee, MI 49660

1391 E Parkdale Ave
Manistee, MI 49660
Phone (231) 398-1760

1400 E Parkdale Ave
Manistee, MI 49660
Phone (231) 398-1840

1465 E Parkdale Ave
Manistee, MI 49660
Phone (231) 398-1000

3021 Schoedel Rd
Manistee, MI 49660
Phone (231) 397-9229

5085 Anna Dr
Ste B
Traverse City, MI 49684
Phone (231) 935-5900

5085 Anna Dr
Ste Bc
Traverse City, MI 49684
Phone (231) 935-5900

Interoperability endpoints

  • Direct secure messaging: charles.vandenberg@wsmcps.eclinicaldirectplus.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/FGJAED/Endpoint/FGJAED

Organizations & group practices 6

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": "1344729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1750638516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1391 E PARKDALE AVE",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496609352",
            "telephone_number": "231-398-1760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1293 E PARKDALE AVE",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496608904",
            "telephone_number": "231-398-1840"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1391 E Parkdale Ave",
            "address_purpose": "LOCATION",
            "city": "Manistee",
            "state": "MI",
            "postal_code": "496609352",
            "country_code": "US",
            "telephone_number": "231-398-1760",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5085 Anna Dr Ste B&c",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496847475",
            "country_code": "US",
            "telephone_number": "231-935-5900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDENBERG",
        "first_name": "CHARLES",
        "middle_name": "JAY",
        "name_suffix": "IV",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-12",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2012020880",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101021764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "charles.vandenberg@wsmcps.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "1391 E Parkdale Ave",
            "city": "Manistee",
            "state": "MI",
            "country_code": "US",
            "postal_code": "496609352",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Manistee, MI

Sources for this page

Verify at the official NPI Registry.