Individual provider Active NPI

Ann S Wittpenn, M.D.

  • Pediatrics Physician
  • Williston, VT
National Provider Identifier
1215952890
Registry record updated Oct 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
42-0009238 Issued in VT
Practice address
353 Blair Park Rd
Williston, VT 05495-7530
Phone
(802) 847-1440
NPI assigned
Jul 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 42-0009238 VT Primary

Addresses

Primary practice location

353 Blair Park Rd
Williston, VT 05495-7530

Mailing address

353 Blair Park Road
Williston, VT 05495
Phone (802) 847-1440

Other identifiers 2

IdentifierTypeStateIssuer
1005386MedicaidVT
E01748232MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060404000411 VT Practitioner - Pediatric Medicine 9234147109 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
42-0009238VTMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Vermont Medical Center Inc Pediatrics CurrentSince Apr 29, 2013 Accepting new patients

Locations

1 S Prospect St
Burlington, VT 05401
Phone (802) 847-4531

353 Blair Park Rd
Williston, VT 05495
Phone (802) 847-1440

Interoperability endpoints

  • Direct secure messaging: awittpenn3863@direct.uvmhealth.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381363200000",
    "number": "1215952890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "353 BLAIR PARK ROAD",
            "city": "WILLISTON",
            "state": "VT",
            "postal_code": "05495",
            "telephone_number": "802-847-1440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "353 BLAIR PARK RD",
            "city": "WILLISTON",
            "state": "VT",
            "postal_code": "054957530",
            "telephone_number": "802-847-1440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITTPENN",
        "first_name": "ANN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-13",
        "last_updated": "2013-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VT",
            "license": "42-0009238",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1005386",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "E01748232",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williston, VT

Sources for this page

Verify at the official NPI Registry.