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Jonathan Christian Vandenberg

Physical Medicine & Rehabilitation

Allopathic & Osteopathic Physicians

235 Wealthy St SE, Grand Rapids, MI 49503-5247

PECOS Enrollment

This provider is enrolled in PECOS as JONATHAN VANDENBERG.

Based on the most recent information from CMS, provider Jonathan Christian Vandenberg is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 10:10 AM.

Profile Details

Provider ID
1730562422
Provider Type
Individual
Full Name
Vandenberg, Jonathan Christian
Title
Dr.
Credential
D.O

Gender
Male
Sole Proprietor
Yes
Enumeration Date
6/30/2015
Last Updated
3/31/2021

Contact Information

Practice Location

235 Wealthy St SE, Grand Rapids, MI 49503-5247

(616) 840-8805

(616) 840-9642

Mailing Location

1331 Moursund Avenue, Bldg. G Rm 115-118, Houston, TX 77030-5389

(713) 799-5033

(713) 797-5982

Provider Taxonomies

Code	Description	License
Code 208100000X Primary	Description Physical Medicine & Rehabilitation Allopathic & Osteopathic Physicians	License 5101025744 Michigan
Code 208100000X	Description Physical Medicine & Rehabilitation Allopathic & Osteopathic Physicians	License 125.066293 Illinois

Jonathan Christian Vandenberg

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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Vollmer, Carolyn

Struble, Taylor J

Nalamasu, Rahul

Nicholson, Joshua Turner

Suzara, Dennis G

Bruinsma, Benjamin J

Cabantan, Dorothy Anne Galang

Heitjan, Frederick

Smith, Meagan Ann