KEVIN VANDOKKUMBURG (PA-C) – Surgical Physician Assistant, NPI 1134514490
Surgical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
6,066 PHYSICIAN ASSISTANT in MI
Provider Addresses for KEVIN VANDOKKUMBURG (PA-C)
3565 MOMENTUM PL
CHICAGO, IL 60689
Phone: (616) 456-8515
Fax: (616) 456-8208
Type: Mailing
350 LAFAYETTE AVE SE
4TH FLOOR
GRAND RAPIDS, MI 495034656
Phone: (616) 456-8515
Fax: (616) 456-8208
Type: Location
2144 E PARIS AVE SE STE 240
GRAND RAPIDS, MI 495466117
Phone: (616) 949-8945
Fax: (616) 949-1115
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $69.
Total Amount is formed as General ($69) + Research ($0) + Ownership ($0) = $69.
Last reported payment date: 2023-01-18 • Largest payer in this snapshot: Heron Therapeutics, Inc. ($69).
Total Amount
$69
General + Research + Ownership
Payments
1
Total payment records
General Amount
$69
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-01-18
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Heron Therapeutics, Inc. | $69 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2015-04-28
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20150428002141 | I | Physician Assistant | MI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| J1040 | Injection, methylprednisolone acetate, 80 mg | 107 | 36 | $0 |
| 20610 | Aspiration and/or injection of fluid from large joint | 102 | 31 | $0 |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 71 | 36 | $0 |
| 73502 | X-ray of hip, 2-3 views | 50 | 41 | $0 |
| 27130 | Replacement of thigh bone and hip joint with prosthesis | 36 | 34 | $0 |
Insurance plans in this area (ZIP 60689)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | MI | 27447 | Repair of knee joint | 27 | 27 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | MI | |
| Sports Medicine | MI | |
| Sports Medicine, Family Practice | MI | |
| Physician Assistant | MI | |
| Nurse Practitioner | MI | |
| N E U R O S U R G E R Y | IL | |
| Physician Assistant | MI | |
| Internal Medicine | MI | |
| Physician Assistant | MI | |
| Physician Assistant | MI |
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