Theodore Richard Van Dam, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A24788 Issued in CA

Practice address

665 Camino de Los Mares
210
San Clemente, CA 92673

Phone

(949) 240-6772

Fax

(949) 240-6841

NPI assigned

Jul 10, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Theodore Vandam M.D.

  • Internal Medicine Physician
  • San Clemente, CA
  • NPI 1699978304
  NPD (past) Authorized official

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1871527226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "665 CAMINO DE LOS MARES",
            "address_2": "210",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "92673",
            "telephone_number": "949-240-6772",
            "fax_number": "949-240-6841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "665 CAMINO DE LOS MARES",
            "address_2": "210",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "92673",
            "telephone_number": "949-240-6772",
            "fax_number": "949-240-6841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DAM",
        "first_name": "THEODORE",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A24788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emelia Rose Tyson, OTD, OTR/L, SWC
• US Express Transport, Inc.
• V.Mai DDS Inc
• Nicole Rachel Vaisman
• Alfred Joseph Valenzuela, PHYSICAL THERAPY
• William L Van Der Reis
• Jessica Marie Van Fleet
• Margaret Anne Vanblerk, MD
• Raeanna Vanderelst
• Vanessa Neal Pediatrics

• Internal Medicine Physician in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.