Individual provider Active NPI

Nathan Paul Vandervinne, DO

  • Emergency Medicine Physician
  • Orangeburg, SC
National Provider Identifier
1902334568
Registry record updated Mar 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
83102 Issued in SC
Practice address
3000 Saint Matthews Rd
Orangeburg, SC 29118-1442
Phone
(803) 395-2000
NPI assigned
May 26, 2017
Last updated
Mar 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 02005448A IN
Student in an Organized Health Care Education/Training Program 390200000X 11019228A IN
Emergency Medicine Physician 207P00000X 83102 SC Primary

Addresses

Primary practice location

3000 Saint Matthews Rd
Orangeburg, SC 29118-1442

Mailing address

25 Old Summer House Rd
Charleston, SC 29412-3227
Phone (815) 618-8424

Other practice location 1

1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone (317) 962-5975

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20200701002000 SC Practitioner - Emergency Medicine 0648548131 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
83102SCMDSports Medicine (Preventive Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sound Physicians Emergency Medicine of South Carolina LLC Emergency Medicine CurrentSince May 24, 2020 Accepting new patients
University Medical Diagnostic Associates, Inc. Past Accepting new patients

Locations

302 University Pkwy
Aiken, SC 29801
Phone (803) 279-3940

3000 Saint Matthews Rd
Orangeburg, SC 29118
Phone (803) 395-2200

Interoperability endpoints

  • Direct secure messaging: nvandervinne446187@direct.musc.edu

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1495756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615766400000",
    "number": "1902334568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 OLD SUMMER HOUSE RD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294123227",
            "telephone_number": "815-618-8424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 SAINT MATTHEWS RD",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291181442",
            "telephone_number": "803-395-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1701 N Senate Blvd",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462021239",
            "country_code": "US",
            "telephone_number": "317-962-5975",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDERVINNE",
        "first_name": "NATHAN",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-26",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "IN",
            "license": "02005448A",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": "11019228A",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "83102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orangeburg, SC

Sources for this page

Verify at the official NPI Registry.