Active NPI
Vernon Integrative Medical Group LLC
- Internal Medicine Physician
- Worcester, MA
National Provider Identifier
1114175627
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 80587
- Legal business name
- VERNON INTEGRATIVE MEDICAL GROUP LLC
- Practice address
- 10 Winthrop St
Worcester, MA 01604 - Phone
- (508) 754-9950
- Fax
- (508) 754-2592
- NPI assigned
- Sep 9, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Jon Trister, M.D.
- Title
- MD Internal Medicine
- Phone
- (508) 754-9950
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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 80587 | MA | Primary |
Addresses
Primary practice location
10 Winthrop St
Worcester, MA 01604
Mailing address
10 Winthrop St
Worcester, MA 01604
Phone (508) 754-9950
Other identifiers 14
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0400664 | Other | EVERCARE | |
| 43899 | Other | MA | BMCHP |
| 5841132 | Other | MA | AETNA |
| 1928586 | Other | CIGNA | |
| 33586 | Other | HEALTH NEW ENGLAND | |
| 110082379A | Medicaid | MA | |
| 29736 | Other | FALLON | |
| 6141990001 | Other | MA | NATIONAL SUPPLIER CLEARINGHOUSE |
| J16290 | Other | BLUE CROSS BLUE SHIELD | |
| 0400053 | Other | UNITED HEALTH CARE | |
| 985162 | Other | NETWORK HEALTH | |
| 3144941 | Medicaid | MA | |
| 080587 | Other | TUFTS | |
| 66212 | Other | HARVARD PILGRIM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
95 Vernon St
Worcester, MA 01610
Phone (508) 755-2466
Practitioners & affiliated clinicians
Practitioners 3
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.
-
- Internal Medicine Physician
- Worcester, MA
- NPI 1639131352
-
- Family Nurse Practitioner
- Worcester, MA
- NPI 1699476036
-
- Physician Assistant
- Worcester, MA
- NPI 1386059947
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220918400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1348099200000",
"number": "1114175627",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 WINTHROP ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01604",
"telephone_number": "508-754-9950",
"fax_number": "508-754-2592"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 WINTHROP ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01604",
"telephone_number": "508-754-9950",
"fax_number": "508-754-2592"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VERNON INTEGRATIVE MEDICAL GROUP LLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-09-09",
"last_updated": "2012-09-20",
"status": "A",
"authorized_official_last_name": "TRISTER",
"authorized_official_first_name": "JON",
"authorized_official_title_or_position": "MD INTERNAL MEDICINE",
"authorized_official_telephone_number": "508-754-9950",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": "MA",
"license": "80587",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EVERCARE",
"identifier": "0400664",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BMCHP",
"identifier": "43899",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5841132",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "1928586",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH NEW ENGLAND",
"identifier": "33586",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110082379A",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FALLON",
"identifier": "29736",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONAL SUPPLIER CLEARINGHOUSE",
"identifier": "6141990001",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "J16290",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "0400053",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NETWORK HEALTH",
"identifier": "985162",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3144941",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "080587",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "66212",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2012; 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.