NPIMap

Organization Active NPI

Vineyard Complementary Medicine, Inc

  • Physical Therapy Clinic/Center
  • Edgartown, MA
National Provider Identifier
1053490896
Registry record updated Dec 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
687 Issued in MA
Legal business name
VINEYARD COMPLEMENTARY MEDICINE, INC
Practice address
238 Edgartown Vineyard Haven Road
Unit 1
Edgartown, MA 02539-6932
Phone
(508) 693-3800
Fax
(508) 693-7473
NPI assigned
Nov 3, 2006
Last updated
Dec 1, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Susan A Sanford, PTNPI 1104905934
Title
President/Ceo
Phone
(508) 693-3800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 687 MA Primary
Occupational Medicine Clinic/Center 261QX0100X
Physical Therapist 225100000X
Occupational Therapist 225X00000X

Addresses

Primary practice location

238 Edgartown Vineyard Haven Road
Unit 1
Edgartown, MA 02539-6932

Mailing address

PO Box 1760
Edgartown, MA 02539-1760
Phone (508) 693-3800

Other practice location 1

455 State Rd
Vineyard Haven, MA 02568-5695
Phone (508) 693-3800

Other practice location 2

9 Main St
Vineyard Haven, MA 02568-5400
Phone (508) 693-3800

Other practice location 3

426 State Rd
Vineyard Haven, MA 02568-5626
Phone (508) 693-3800

Other identifiers 2

IdentifierTypeStateIssuer
Y61445OtherMABCBS OF MA
AA52541OtherHPHC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050608000387 MA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2860435005 Receives reassigned benefits from 7 practitioners
Practice locations: Edgartown, MA; Vineyard Haven, MA
O20170310000520 MA Part B Supplier - Clinic/Group Practice 2860435005 Receives reassigned benefits from 4 practitioners
1 other NPI on this enrollment
Practice locations: Edgartown, MA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

238 Edgartown Vineyard Haven Rd
Edgartown, MA 02539
Phone (508) 693-3800

426 State Rd
Vineyard Haven, MA 02568
Phone (508) 693-3800

455 State Rd
Vineyard Haven, MA 02568
Phone (508) 696-1863

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606780800000",
    "number": "1053490896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1760",
            "city": "EDGARTOWN",
            "state": "MA",
            "postal_code": "025391760",
            "telephone_number": "508-693-3800",
            "fax_number": "508-693-7473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "238 EDGARTOWN VINEYARD HAVEN ROAD",
            "address_2": "UNIT 1",
            "city": "EDGARTOWN",
            "state": "MA",
            "postal_code": "025396932",
            "telephone_number": "508-693-3800",
            "fax_number": "508-693-7473"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "455 State Rd",
            "address_purpose": "LOCATION",
            "city": "Vineyard Haven",
            "state": "MA",
            "postal_code": "025685695",
            "country_code": "US",
            "telephone_number": "508-693-3800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9 Main St",
            "address_purpose": "LOCATION",
            "city": "Vineyard Haven",
            "state": "MA",
            "postal_code": "025685400",
            "country_code": "US",
            "telephone_number": "508-693-3800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "426 State Rd",
            "address_purpose": "LOCATION",
            "city": "Vineyard Haven",
            "state": "MA",
            "postal_code": "025685626",
            "country_code": "US",
            "telephone_number": "508-693-3800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VINEYARD COMPLEMENTARY MEDICINE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A",
        "authorized_official_last_name": "SANFORD",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "508-693-3800",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MA",
            "license": "687",
            "primary": true
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MA",
            "identifier": "Y61445",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HPHC",
            "identifier": "AA52541",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgartown, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.