NPIMap

Organization Active NPI

Shelburne Pediatrics

  • Pediatrics Physician
  • Shelburne, VT
National Provider Identifier
1164624300
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SHELBURNE PEDIATRICS
Practice address
10 Marsett Rd
Suite 2
Shelburne, VT 05482-6640
Phone
(802) 985-5099
Fax
(802) 985-2336
NPI assigned
Jun 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jeanne Kellner, MDNPI 1760559108
Title
Owner
Phone
(802) 985-5099

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)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X VT Primary

Addresses

Primary practice location

10 Marsett Rd
Suite 2
Shelburne, VT 05482-6640

Mailing address

10 Marsett Rd
Suite 2
Shelburne, VT 05482-6640
Phone (802) 985-5099

Other identifiers 1

IdentifierTypeStateIssuer
1012925MedicaidVT

National Provider Directory

National Provider Directory

Locations

10 Marsett Rd
Ste 2
Shelburne, VT 05482
Phone (802) 985-5099

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/12033/brand/1/csg/1/fhir/r4

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.

NPI Registry JSON

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

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164624300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 MARSETT RD",
            "address_2": "SUITE 2",
            "city": "SHELBURNE",
            "state": "VT",
            "postal_code": "054826640",
            "telephone_number": "802-985-5099",
            "fax_number": "802-985-2336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 MARSETT RD",
            "address_2": "SUITE 2",
            "city": "SHELBURNE",
            "state": "VT",
            "postal_code": "054826640",
            "telephone_number": "802-985-5099",
            "fax_number": "802-985-2336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELBURNE PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KELLNER",
        "authorized_official_first_name": "JEANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "802-985-5099",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "VT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1012925",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelburne, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.