NPIMap

Organization Active NPI

Matrix Health Systems P.C.

  • Clinical Psychologist
  • Burlington, VT
National Provider Identifier
1104872712
Registry record updated Nov 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
MATRIX HEALTH SYSTEMS P.C.
Practice address
86 Lake St
Burlington, VT 05401-5297
Phone
(802) 865-3450
Fax
(802) 860-5011
NPI assigned
May 25, 2006
Last updated
Nov 21, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2014

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

Authorized official

Name
Dr. David Fassler, M.D.NPI 1275558702
Title
Clinical Director
Phone
(802) 865-3450

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

86 Lake St
Burlington, VT 05401-5297

Mailing address

86 Lake St
Burlington, VT 05401-5297
Phone (802) 865-3450

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031230000156 VT Part B Supplier - Clinic/Group Practice 1052219359 Receives reassigned benefits from 37 practitioners
Practice locations: Shelburne, VT; Winooski, VT; South Burlington, VT; Burlington, VT; Brattleboro, VT; Essex JCT, VT

National Provider Directory

National Provider Directory
Tax ID family
Crossroads2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

49 The Sq
Bellows Falls, VT 05101
Phone (603) 209-6100

49 Village Sq
Bellows Falls, VT 05101
Phone (603) 313-5186

80 Linden St
Brattleboro, VT 05301
Phone (802) 254-2291

70 S Winooski Ave
Ste 2B
Burlington, VT 05401
Phone (802) 377-7810

15 Pinecrest Dr
Essex Junction, VT 05452
Phone (802) 288-1087

55 Main St
Ste 4
Essex Junction, VT 05452
Phone (802) 879-1802

47 Court St
Middlebury, VT 05753
Phone (802) 377-9448

79 Court St
Middlebury, VT 05753
Phone (802) 388-4249

11 Beaver Meadow Rd
#4
Norwich, VT 05055
Phone (802) 649-2260

486 Main St
Winooski, VT 05404

Practitioners & affiliated clinicians

Practitioners 90

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 90

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416528000000",
    "number": "1104872712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 LAKE ST",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054015297",
            "telephone_number": "802-865-3450",
            "fax_number": "802-860-5011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 LAKE ST",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054015297",
            "telephone_number": "802-865-3450",
            "fax_number": "802-860-5011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATRIX HEALTH SYSTEMS P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2014-11-21",
        "status": "A",
        "authorized_official_last_name": "FASSLER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "802-865-3450",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2014; 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.