Meta Eliza Surjaputra

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

048.0135289 Issued in VT

Practice address

111 Colchester Ave
Burlington, VT 05401-1473

Phone

(802) 847-3634

Fax

(802) 847-8961

NPI assigned

Jun 10, 2021

Sex

Female

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

Enrolled in VT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

University of Vermont Medical Center IncGroup PAC ID 3779491071, 1,208 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Univ. of Vermont - Fletcher Allen Health Care Hospital, Burlington, VT, CCN 470003

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: msurjaputra541725@direct.uvmhealth.org

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.

• University of Vermont Medical Center Inc

  • Internal Medicine Physician
  • Burlington, VT
  • NPI 1659309615
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• University of Vermont Medical Center Inc

  • General Acute Care Hospital
  • Burlington, VT
  • NPI 1568419976
  Care Compare affiliation

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

{
    "created_epoch": "1623283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760572800000",
    "number": "1093382616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 COLCHESTER AVE",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054011473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 COLCHESTER AVE",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054011473",
            "telephone_number": "802-847-3634",
            "fax_number": "802-847-8961"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "333 N Michigan Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606013901",
            "country_code": "US",
            "telephone_number": "312-815-9660",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SURJAPUTRA",
        "first_name": "META",
        "middle_name": "ELIZA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-10",
        "last_updated": "2025-10-16",
        "certification_date": "2025-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VT",
            "license": "048.0135289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robin Ann Sumner
• Samantha Mei Sun
• Sunrise Counseling and Wellness
• Thomas Suppan, M.D.
• Benjamin Tate Suratt, M.D.
• John Surprenant, LICSW
• Kate D. Suskin, M.S.W.
• Betsy L. Sussman, M.D.
• Sally Sutton, LICSW
• Aathman Swaminathan, MD

• Clinical Psychologist in Burlington, VT
• Providers in Burlington, VT by specialty
• Clinical Psychologist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.