Tyler Vanadurongvan, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

R-12297 Issued in IA

Practice address

2501 Pierce St
Sioux City, IA 51104-3725

Phone

(712) 294-5000

NPI assigned

Jun 27, 2021

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 IA

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

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

{
    "created_epoch": "1624752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624752000000",
    "number": "1972173524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 4TH ST APT 504",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511011702",
            "telephone_number": "612-239-3938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 PIERCE ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511043725",
            "telephone_number": "712-294-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANADURONGVAN",
        "first_name": "TYLER",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-27",
        "last_updated": "2021-06-27",
        "certification_date": "2021-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "R-12297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Unitypoint at Home
• Unitypoint at Home
• Gabriela Valdovinos-Cancino, LMSW
• Toni Malia Beck Van Dusen
• Lindsay Van Dyke, ARNP
• Jeremy John Vande Zande, M.D.
• Bailea Rose Vanden Bosch
• David Vandyke, CRNA
• Dennis Roy Vannatta, O.D.
• Allison A Vanotterloo, NP-C

• Family Medicine Physician in Sioux City, IA
• Providers in Sioux City, IA by specialty
• Family Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2021; 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.