Nathan Paul Vandervinne, DO
Individual provider Active NPI Emergency Medicine Physician · Orangeburg, SC
NPI 1902334568 · NPPES record last updated Mar 15, 2021
Key facts
- NPI
- 1902334568
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 83102 (SC)
- Practice address
- 3000 Saint Matthews Rd
Orangeburg, SC 29118-1442 - Phone
- (803) 395-2000
- NPI assigned
- May 26, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200701002000 | SC | Practitioner - Emergency Medicine | 0648548131 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11019228A | IN | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sound Physicians Emergency Medicine of South Carolina LLC | Emergency Medicine | Current |
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
- nvandervinne446187@direct.musc.edu
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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 | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300015976 | Medicaid | IN |
Other providers in Orangeburg, SC
- United Dental Group, LLC
- United Rehab Inc
- Kevin Scott Uren
- Sabrina Valentine
- Valtic
- Robert A. Varn
- William Varn
- Veil Home Health and Hospice LLC
- Veil Home Health and Hospice, LLC
- Vein Center MD, LLC
All providers in Orangeburg, SC · Emergency Medicine Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 15, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.