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Deactivated NPI 1194789016 Deactivated / Inactive NPI Male Practitioner

Dr. Paul C Vanderbilt , MD

Surgery • Blue Island, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Paul Vanderbilt has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date April 17, 2006
NPI Deactivation Date October 01, 2020
Total Practice Duration ~14 Years of Practice (2006 – 2020)

Professional Overview & Biography Verified Profile Summary

Dr. Paul Vanderbilt, MD was a registered Surgery practicing in Blue Island, IL. Throughout an active medical career spanning 14 years, Dr. Vanderbilt provided care at the practice location at 2320 HIGH ST until profile deactivation on 2020-10-01.

Practice Location & Contact Primary Location

Practice Address

2320 High St
Retired 2-15-2012

Blue Island, IL 604062426

Telephone 7083885500
Associated Practice Facility / Clinic
🏢 Dupage Medical Group, Ltd Facility NPI 1700839230

Specialty Benchmarks & Practice Insights

Comparative analytics for Surgery in Blue Island, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 39.0 Yrs
State Avg: 27.3 Yrs
Regional Practice Density
3 Specialists

Practicing in Blue Island, IL (1624 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Surgery Primary Specialty

NUCC Taxonomy Code: 208600000X

State License IL 036039153

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

23 Associated Practitioners
NPI 1003870387

Doctor of Osteopathic Medicine (D.O.)

Dr. Miyoung Won , MD

General Practice

NPI 1023072378

Doctor of Medicine (M.D.)

Catherine Czaja , APRN

Nurse Practitioner

NPI 1073183364

Advanced Practice Registered Nurse

Dr. Shing Yen , MD

Orthopaedic Surgery

NPI 1093779373

Doctor of Medicine (M.D.)

Dr. Randall Gordon , MD

Obstetrics & Gynecology

NPI 1174512925

Doctor of Medicine (M.D.)

Dr. Jose Manglano , MD

Obstetrics & Gynecology - Gynecology

NPI 1295799567

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated October 01, 2020

Record deactivated on October 01, 2020

NPI Profile Active July 28, 2015

NPI status registered as active in NPPES database

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Updated Practice Location July 28, 2015

Registered at 2320 HIGH ST, RETIRED 2-15-2012, BLUE ISLAND, IL 604062426 (Tel: 7083885500)

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Updated Business Mailing Address July 28, 2015

Registered at 2320 HIGH ST, RETIRED 2-15-2012, BLUE ISLAND, IL 604062426 (Tel: 7083885500)

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Provider Name / Credentials Updated July 28, 2015

Recorded as PAUL VANDERBILT, MD

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 28, 2015

Surgery (License #036039153 in IL)

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Initial NPI Registration & Enumeration April 17, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1194789016
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 17, 2006
Last Update: July 28, 2015
Deactivation Date: October 01, 2020

Mailing Address

2320 High St, Retired 2-15-2012

Blue Island, IL 604062426

Phone: 7083885500

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.