Benjamin P Cooke, PAC
Individual provider Active NPI Physician Assistant · St Albans, VT
NPI 1144257585 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1144257585
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 0550030525 (VT)
- Practice address
- 133 Fairfield St
St Albans, VT 05478-1726 - Phone
- (802) 524-5911
- Fax
- (802) 524-1057
- NPI assigned
- Jun 28, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091022000723 | VT | Practitioner - Physician Assistant | 9638216682 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0550030525 | VT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwestern Medical Center Inc | Current |
Accepting new patients | |
| Northwestern Medical Center, Inc | Current |
Accepting new patients | |
| Northwestern Medical Center, Inc. | Current |
Accepting new patients |
Locations
3 Crest Rd
Saint Albans, VT 05478
Phone (802) 524-4554
133 Fairfield St
Saint Albans, VT 05478
Phone (802) 524-1227
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0550030525 | VT | Yes |
Addresses
Primary practice location
133 Fairfield St
St Albans, VT 05478-1726
Mailing address
133 Fairfield St
St Albans, VT 05478-1726
Phone (802) 524-5911
Other providers in St Albans, VT
- Anna Comiskey
- Laura R Companion
- Kristen Kelly Connolly
- Kaylee Allison Conover
- Veronica Cook
- Mark Coons
- Eugenia Lamet Corbett
- Meghan Corrigan
- Kathleen M Costello
- Kim Cotnoir
All providers in St Albans, VT · Physician Assistant in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.