NPIMap

Individual provider Active NPI

Trisha Mae Bullard, PA-C, PTA

  • Surgical Physician Assistant
  • St Johnsbury, VT
National Provider Identifier
1114333093
Registry record updated Nov 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
055.0031399 Issued in VT
Practice address
1315 Hospital Dr
St Johnsbury, VT 05819
Phone
(802) 748-8141
NPI assigned
Jul 11, 2014
Last updated
Nov 9, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 055.0031399 VT Primary
Physical Therapy Assistant 225200000X 1054 NH

Addresses

Primary practice location

1315 Hospital Dr
St Johnsbury, VT 05819

Mailing address

128 Woodland Dr
Barre, VT 05641-3317
Phone (802) 274-2421

Other practice location 1

4780 US Rte 5 N
St Johnsbury, VT 05819-9049
Phone (802) 274-2421

Other names 1

  • Trisha Mae Jewell Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181010002620 VT Practitioner - Physician Assistant 8921350471 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeastern Vermont Regional Hospital IncGroup PAC ID 3678481405, shared by 15 NPIs, 104 clinicians

Practice addresses (Care Compare)

1315 Hospital Dr
Saint Johnsbury, VT 05819-9210
Phone (802) 748-7300

PO Box
St Johnsbury, VT 05819-0905

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1054NHMDAddiction (Substance Use Disorder) Counselor
055.0031399VTMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Counties Health Care, Inc. CurrentSince Feb 27, 2023 Accepting new patients
Northeastern Vermont Regional Hospital, Inc Current Accepting new patients
Northeastern Vermont Regional Hospital, Inc CurrentSince Sep 1, 2025 Accepting new patients
Northeastern Vermont Regional Hospital, Inc CurrentSince Sep 10, 2019 Accepting new patients
Northeastern Vermont Regional Hospital, Inc Current Accepting new patients
Northern Counties Health Care Inc CurrentSince Feb 27, 2023 Accepting new patients
Northeastern Vermont Regional Hospital Inc. CurrentSince Sep 11, 2018 Accepting new patients
Northeastern Vermont Regional Hospital Inc Current Accepting new patients
Northeastern Vermont Regional Hospital, Inc CurrentSince Sep 10, 2019 Accepting new patients
Northeastern Vermont Regional Hospital, Inc CurrentSince Sep 11, 2018 Accepting new patients
Northeastern Vermont Regional Hospital, Inc. Past Accepting new patients

Locations

26 Cedar Ln
Danville, VT 05828
Phone (802) 684-2275

195 Industrial Pkwy
Lyndonville, VT 05851

195 Industrial Pkwy
#1
Lyndonville, VT 05851

1315 Hospital Dr
St Johnsbury, VT 05819
Phone (802) 748-3638

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1405036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541721600000",
    "number": "1114333093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 WOODLAND DR",
            "city": "BARRE",
            "state": "VT",
            "postal_code": "056413317",
            "telephone_number": "802-274-2421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 HOSPITAL DR",
            "city": "ST JOHNSBURY",
            "state": "VT",
            "postal_code": "05819",
            "telephone_number": "802-748-8141"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4780 US Rte 5 N",
            "address_purpose": "LOCATION",
            "city": "St Johnsbury",
            "state": "VT",
            "postal_code": "058199049",
            "country_code": "US",
            "telephone_number": "802-274-2421",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BULLARD",
        "first_name": "TRISHA",
        "middle_name": "MAE",
        "credential": "PA-C, PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-11",
        "last_updated": "2018-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "VT",
            "license": "055.0031399",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NH",
            "license": "1054",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRISHA",
            "last_name": "JEWELL",
            "middle_name": "MAE",
            "credential": "PTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in St Johnsbury, VT

Sources for this page

Verify at the official NPI Registry.