Individual provider Active NPI

Elizabeth Church Vanderaue, D.O.

  • Emergency Medicine Physician
  • Pontiac, MI
National Provider Identifier
1790904936
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
5101016581 Issued in MI
Practice address
50 N Perry St
Pontiac, MI 48342-2217
Phone
(248) 338-5000
NPI assigned
Apr 25, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 5101016581 MI Primary

Addresses

Primary practice location

50 N Perry St
Pontiac, MI 48342-2217

Mailing address

3745 Cass Elizabeth Rd Apt 304
Waterford, MI 48328-4542
Phone (248) 390-3627

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080320000670 MI Practitioner - Emergency Medicine 0840376570 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Missouri, Kansas City, School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstreet Urgent Care of MichiganGroup PAC ID 6305188491, 129 clinicians

Practice addresses (Care Compare)

845 S Lapeer Rd
Lake Orion, MI 48362-2925
Phone (248) 469-0011

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstreet Urgent Care of Michigan CurrentSince Aug 27, 2024 Accepting new patients
McLaren Medical Group Emergency Medicine CurrentSince Aug 6, 2023 Accepting new patients
Degara App, PLLC Emergency Medicine CurrentSince Feb 12, 2017 Accepting new patients
McLaren Medical Group CurrentSince Aug 6, 2023 Accepting new patients
Wellstreet Urgent Care of Michigan PastSince Aug 6, 2023 Accepting new patients

Locations

1100 S Van Dyke Rd
Bad Axe, MI 48413
Phone (989) 269-9521

5701 Bow Pointe Dr
Ste 120
Clarkston, MI 48346
Phone (248) 625-2273

5979 Lakeshore Rd
Fort Gratiot, MI 48059
Phone (810) 385-6370

845 S Lapeer Rd
Lake Orion, MI 48362
Phone (248) 469-0011

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

1254 N Main St
Lapeer, MI 48446
Phone (810) 664-4531

50 N Perry St
Pontiac, MI 48342
Phone (248) 338-5300

2078 E Big Beaver Rd
Troy, MI 48083
Phone (248) 855-4134

Organizations & group practices 5

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 3

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": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790904936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3745 CASS ELIZABETH RD APT 304",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483284542",
            "telephone_number": "248-390-3627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 N PERRY ST",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483422217",
            "telephone_number": "248-338-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERAUE",
        "first_name": "ELIZABETH",
        "middle_name": "CHURCH",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101016581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pontiac, MI

Sources for this page

Verify at the official NPI Registry.