Kelle Rae Shutter, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

042.0015262 Issued in VT

Practice address

21 Belmont Ave
Brattleboro, VT 05301-7110

Phone

(802) 258-3905

Fax

(802) 258-4903

NPI assigned

Sep 28, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Dr. Kelle Rae Herning Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA, VT2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: drshutter@pchpmd.medentdirect.com
• FHIR API: https://fhir-myrecord.cerner.com/r4/d9dc001d-1bc5-42f9-bd4d-eb79208fd32a/

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.

• Brattleboro Memorial Hospital

  • General Acute Care Hospital
  • Brattleboro, VT
  • NPI 1306849708

  Pediatrics

  Medicare reassignment NPD
• Primary Care Health Partners - Vermont LLP

  • Family Medicine Physician
  • Williston, VT
  • NPI 1285687616

  Pediatrics

  Medicare reassignment NPD
• Seattle Children'S Hospital

  • Specialist
  • Seattle, WA
  • NPI 1003319500
  Medicare reassignment NPD
• The Polyclinic PLLC

  • Audiologist
  • Seattle, WA
  • NPI 1174594634

  Pediatrics

  Medicare reassignment NPD
• Primary Care Health Partners - New York LLP

  • Family Medicine Physician
  • Plattsburgh, NY
  • NPI 1003861782

  Pediatrics

  NPD
• Seattle Children'S Hospital

  • Children's Hospital
  • Seattle, WA
  • NPI 1467536276
  NPD
• Seattle Childrens Hospital

  • Clinic Pharmacy
  • Seattle, WA
  • NPI 1245342153
  NPD
• The Polyclinic

  • Radiation Oncology Physician
  • Seattle, WA
  • NPI 1962824219
  NPD
• The Polyclinic PLLC

  • Durable Medical Equipment & Medical Supplies
  • Tacoma, WA
  • NPI 1831411487
  NPD

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

{
    "created_epoch": "1254096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1235463092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 BLAIR PARK RD STE 285",
            "city": "WILLISTON",
            "state": "VT",
            "postal_code": "054957586",
            "telephone_number": "802-288-1140",
            "fax_number": "802-288-1144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 BELMONT AVE",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "053017110",
            "telephone_number": "802-258-3905",
            "fax_number": "802-258-4903"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17 Belmont Ave",
            "address_purpose": "LOCATION",
            "city": "Brattleboro",
            "state": "VT",
            "postal_code": "053013498",
            "country_code": "US",
            "telephone_number": "802-257-0341",
            "fax_number": "802-257-8834",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHUTTER",
        "first_name": "KELLE",
        "middle_name": "RAE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-28",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD60500534",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VT",
            "license": "042.0015262",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6706620",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3127306",
            "state": "NH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "drshutter@pchpmd.medentdirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "21 Belmont Ave",
            "city": "Brattleboro",
            "state": "VT",
            "country_code": "US",
            "postal_code": "053017110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KELLE",
            "last_name": "HERNING",
            "middle_name": "RAE",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Anne Sherman
• Katelyn-Ann Sherman
• Shine Speech Therapy LLC
• Sarah Shine, MS CCC-SLP
• Maya J. Shulman-Ment, MSW
• Rebecca Sue Shwartz, ND, MSA
• Janet Sinclair, LIC. AC.
• Heather Sluter
• Heather Leigh Smith, LCMHC
• Houghton Paul Smith, RN CDE

• Pediatrics Physician in Brattleboro, VT
• Providers in Brattleboro, VT by specialty
• Pediatrics Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.