Thomas Carmine Vandeven, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

60297543 Issued in WA

Practice address

819 S 13TH St
SRC Residency Clinic
Mount Vernon, WA 98274-4112

Phone

(360) 814-6230

NPI assigned

Jul 25, 2012

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2018 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Dietrich & Smith Clinic Inc P S

  • Primary Care Clinic/Center
  • Sedro Woolley, WA
  • NPI 1336145846
  NPD (past)

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

{
    "created_epoch": "1343174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377475200000",
    "number": "1972859114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "819 S 13TH ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744112",
            "telephone_number": "360-814-6230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 S 13TH ST",
            "address_2": "SRC RESIDENCY CLINIC",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744112",
            "telephone_number": "360-814-6230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDEVEN",
        "first_name": "THOMAS",
        "middle_name": "CARMINE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-25",
        "last_updated": "2013-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "60297543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Sue Van de Grift, LMP
• Lazia Van Wieringen, PA-C
• Alyne Bell Van Winkle
• Maria Van-Nurden, O.D.
• Jonathan James Vander Schuur, M.S.
• Gabriella Marie Vanek, M.S., CCC-SLP
• Robert J. Vanmale, MS, LMHC, CMHS, MHP
• Stacey S Vanwaveren, LMT
• Vanwell Counseling PLLC
• Kerry Lexene Vanwinkle-Koeppen, LMP

• Family Medicine Physician in Mount Vernon, WA
• Providers in Mount Vernon, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2013; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.