Thomas Jackson Vandiver, MD

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

24305 Issued in NC

Practice address

150 Providence Rd
Charlotte, NC 28207-1218

Phone

(704) 973-2106

Fax

(704) 973-2395

NPI assigned

Oct 24, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

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

Practice roles

Locations

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.

• Novant Health Medical Group, LLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Charlotte, NC
  • NPI 1306950282
  Medicare reassignment NPD
• Novant Health Medical Group, LLC

  • Obstetrics & Gynecology Physician
  • Charlotte, NC
  • NPI 1104081959
  NPD

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426032000000",
    "number": "1902896756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-973-2106",
            "fax_number": "704-973-2395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 PROVIDENCE RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071218",
            "telephone_number": "704-973-2106",
            "fax_number": "704-973-2395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDIVER",
        "first_name": "THOMAS",
        "middle_name": "JACKSON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-24",
        "last_updated": "2015-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "NC",
            "license": "24305",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8984676",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margarette Megan Vanderploeg, PA
• Craig Andrew Vanderveer, MD
• Yenny Astrid-Angel Vanderwaerden, MD
• Mark Roger Vanderwel, MD
• Stacey Ann Vanderwel, RD, CSP, LDN
• Lesley Vandyck, MS CCC-SLP
• Roy Neil Vandyke, D.C.
• Ashley M Vanexel
• Kong Vang, DMD
• Lee Christopher Vang, DC

• Gynecology Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Gynecology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2015; 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.