NPIMap

Individual provider Active NPI

Mark Edward Logan, MD

  • Internal Medicine Physician
  • Rutland, VT
National Provider Identifier
1184679227
Registry record updated Jun 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
042-0006819 Issued in VT
Practice address
199 Stratton Rd
Rutland, VT 05701-4621
Phone
(802) 775-7798
NPI assigned
May 24, 2006
Last updated
Jun 9, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 042-0006819 VT Primary

Addresses

Primary practice location

199 Stratton Rd
Rutland, VT 05701-4621

Mailing address

199 Stratton Rd
Rutland, VT 05701-4621
Phone (802) 775-7798

Other identifiers 3

IdentifierTypeStateIssuer
61-1488339OtherVTTAX ID
0005483MedicaidVT
042-0006819OtherVTLICENSE

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
I20050916000609 VT Practitioner - Addiction MedicinePractitioner - Internal MedicinePractitioner - General PracticePractitioner - Family Practice 3678476751 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Addiction MedicineAlso: Internal Medicine
Education
University of Vermont College of Medicine, 1979
Medicare assignment
May accept Medicare assignment
Group practices
Connecticut Valley Addiction Recovery IncGroup PAC ID 1850710179, 6 clinicians

Practice addresses (Care Compare)

220 Holiday Dr
Suite a
White River Junction, VT 05001-2015
Phone (802) 674-9400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
042-0006819VTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Connecticut Valley Addiction Recovery, Inc CurrentSince Mar 6, 2023 Accepting new patients
Bradford Psychiatric Associates. LLC Internal Medicine Past Accepting new patients
Vermont Physicians Clinic Family Medicine Past Accepting new patients
Oas, LLC Past Accepting new patients
Casa Grande Emergency Physicians PLLC PastSince May 1, 2001 Accepting new patients

Locations

220 Holiday Dr
Ste A
White River Junction, VT 05001
Phone (802) 281-6364

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24449/brand/1/csg/1/fhir/r4

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307577600000",
    "number": "1184679227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 STRATTON RD",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014621",
            "telephone_number": "802-775-7798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 STRATTON RD",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014621",
            "telephone_number": "802-775-7798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGAN",
        "first_name": "MARK",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2011-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VT",
            "license": "042-0006819",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "61-1488339",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005483",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "042-0006819",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rutland, VT

Sources for this page

Verify at the official NPI Registry.