NPIMap

Individual provider Active NPI

Kathryn Anne Macksoud

  • Physician Assistant
  • Springfield, VT
National Provider Identifier
1194486357
Registry record updated Jun 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
055.0031598 Issued in VT
Practice address
100 River St
Springfield, VT 05156-2930
Phone
(802) 886-8900
NPI assigned
Jan 9, 2022
Last updated
Jun 5, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 055.0031598 VT Primary

Addresses

Primary practice location

100 River St
Springfield, VT 05156-2930

Mailing address

24 Airport Rd
West Lebanon, NH 03784

Other practice location 1

24 Airport Rd
West Lebanon, NH 03784
Phone (603) 298-5549

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
I20220811002287 VT Practitioner - Physician Assistant 2062895899 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Hospital CT
Bellows Falls, VT 05101-1489
Phone (802) 463-9000

100 River St
Springfield, VT 05156-2930
Phone (802) 886-8900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
055.0031598VTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Springfield Medical Care Systems Inc CurrentSince Jul 11, 2022 Accepting new patients
Springfield Medical Care Systems Inc. CurrentSince Jul 11, 2022 Accepting new patients

Locations

1 Hospital Ct
Bellows Falls, VT 05101
Phone (802) 463-1292

100 River St
Springfield, VT 05156
Phone (802) 886-8900

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/21546/brand/1/csg/1/fhir/r4
  • Direct secure messaging: kathryn.macksoud.1@24182.direct.athenahealth.com

Organizations & group practices 2

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 9

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": "1641686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654387200000",
    "number": "1194486357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 AIRPORT RD",
            "city": "WEST LEBANON",
            "state": "NH",
            "postal_code": "03784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 RIVER ST",
            "city": "SPRINGFIELD",
            "state": "VT",
            "postal_code": "051562930",
            "telephone_number": "802-886-8900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24 Airport Rd",
            "address_purpose": "LOCATION",
            "city": "West Lebanon",
            "state": "NH",
            "postal_code": "03784",
            "country_code": "US",
            "telephone_number": "603-298-5549",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACKSOUD",
        "first_name": "KATHRYN",
        "middle_name": "ANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-09",
        "last_updated": "2022-06-05",
        "certification_date": "2022-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VT",
            "license": "055.0031598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, VT

Sources for this page

Verify at the official NPI Registry.