NPIMap

Organization Active NPI

Performance Orthopedic Design LLC

Doing business as Mountain Orthotic & Prosthetic Services

  • Prosthetic/Orthotic Supplier
  • South Burlington, VT
National Provider Identifier
1184595738
Registry record updated Sep 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
PERFORMANCE ORTHOPEDIC DESIGN LLC
Doing business as
Mountain Orthotic & Prosthetic Services
Practice address
193 Tilley Dr Ste 103
South Burlington, VT 05403-4440
Phone
(518) 324-6569
Fax
(518) 324-6570
NPI assigned
Sep 16, 2025
Last updated
Sep 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2025

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

Authorized official

Name
Brittany Anne Williams
Title
Practice Manager
Phone
(518) 324-6569

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X NU Primary

Addresses

Primary practice location

193 Tilley Dr Ste 103
South Burlington, VT 05403-4440

Mailing address

7 Old Military Rd
Lake Placid, NY 12946-1614
Phone (518) 324-6569

Other names 1

  • Mountain Orthotic & Prosthetic Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260603000072 VT DME Supplier - Prosthetic PersonnelDME Supplier - Orthotic PersonnelDME Supplier - Certified Orth/Pros/PedorthistDME Supplier - Pedorthic Personnel 5890990857 Practice locations: South Burlington, VT

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Performance Orthopedic Design LLC193 Tilley Dr, South Burlington, VT 05403-4440(802) 861-6185 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items Does not accept assignmentParticipating since Sep 10, 2007

National Provider Directory

National Provider Directory
Tax ID family
Performance Orthopedic Design LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

193 Tilley Dr
Ste 103
South Burlington, VT 05403
Phone (518) 324-6569

NPI Registry JSON

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

{
    "created_epoch": "1757980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758153600000",
    "number": "1184595738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 OLD MILITARY RD",
            "city": "LAKE PLACID",
            "state": "NY",
            "postal_code": "129461614",
            "telephone_number": "518-324-6569",
            "fax_number": "518-324-6570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "193 TILLEY DR STE 103",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054034440",
            "telephone_number": "518-324-6569",
            "fax_number": "518-324-6570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE ORTHOPEDIC DESIGN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-16",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "518-324-6569"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Orthotic & Prosthetic Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Burlington, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.