Larry Wayne Vandermolen, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

99042551A Issued in IN

Practice address

2626 E Covenanter CT
Bloomington, IN 47401-5408

Phone

(812) 345-5556

NPI assigned

Jun 7, 2010

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 IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Pike Medical Consultants PC

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  • NPI 1770689242
  Medicare reassignment

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

{
    "created_epoch": "1275868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279584000000",
    "number": "1942520507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2626 E COVENANTER CT",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474015408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2626 E COVENANTER CT",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474015408",
            "telephone_number": "812-345-5556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERMOLEN",
        "first_name": "LARRY",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-07",
        "last_updated": "2010-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "99042551A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "10001177A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alyssa Rose Van Duzer, PA-C
• Mary Van Kooten, MD
• Karen Vanarsdale, LCSW
• Paul Joseph Vandekoppel, MD
• Madeleine Jane Vandenbrink, MD
• David Vandeventer, BCBA
• Jason R Vandeventer, MPT
• Vickie L Vandeventer, FNP
• Grace Vandiver
• Sandra Ellen Vangilder

• Physician Assistant in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2010; 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.