NPIMap

Individual provider Active NPI

Edwin Goncharuk, D.O.

  • Gastroenterology Physician
  • Burlington, VT
National Provider Identifier
1255872453
Registry record updated Aug 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
032-0133900 Issued in VT
Practice address
111 Colchester Ave
Uvmmc
Burlington, VT 05401-1473
Phone
(802) 847-2345
NPI assigned
Mar 20, 2017
Last updated
Aug 27, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 032-0133900 VT
Gastroenterology Physician 207RG0100X 330524 NY
Gastroenterology Physician 207RG0100X 032-0133900 VT Primary
Hospitalist Physician 208M00000X 032-0133900 VT

Addresses

Primary practice location

111 Colchester Ave
Uvmmc
Burlington, VT 05401-1473

Mailing address

111 Colchester Ave
Uvmmc
Burlington, VT 05401-1473

Other practice location 1

130 Fisher Rd
Berlin, VT 05602-9516
Phone (802) 225-1743

Other practice location 2

77 Plaza Blvd
Plattsburgh, NY 12901-6438
Phone (518) 825-4437

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200716000429 VT Practitioner - HospitalistPractitioner - Internal Medicine 7012289507 Reassigns benefits to 3 organizations
I20250825003342 NY Practitioner - Gastroenterology 7012289507 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
University of New England, College of Osteo Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

111 Colchester Ave
Burlington, VT 05401-1473
Phone (802) 847-0000

75 Beekman St
Plattsburgh, NY 12901-1438
Phone (518) 561-2000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy64
Upper gastrointestinal (GI) endoscopy for acid reflux58

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
032-0133900VTMDGastroenterology Physician
330524NYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Central Vermont Medical Center Inc Internal Medicine CurrentSince Jul 1, 2020 Accepting new patients
Champlain Valley Physicians Hospital Medical Center Internal Medicine CurrentSince Aug 14, 2025 Accepting new patients
University of Vermont Medical Center Inc Internal Medicine CurrentSince Jul 1, 2020 Accepting new patients
Central Vermont Medical Center Inc Internal Medicine CurrentSince Jul 1, 2020 Accepting new patients

Locations

75 Beekman St
Plattsburgh, NY 12901
Phone (518) 562-7100

77 Plaza Blvd
#101
Plattsburgh, NY 12901
Phone (518) 562-7171

130 Fisher Rd
Barre, VT 05641
Phone (802) 371-4235

130 Fisher Rd
Berlin, VT 05602
Phone (802) 225-5820

130 Fisher Rd
#C
Berlin, VT 05602
Phone (802) 225-5400

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

111 Colchester Ave
Burlington, VT 05401
Phone (802) 656-2415

Interoperability endpoints

  • Direct secure messaging: egoncharuk164214@direct.uvmhealth.org

Organizations & group practices 4

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 21

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1489968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756252800000",
    "number": "1255872453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 COLCHESTER AVE",
            "address_2": "UVMMC",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054011473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 COLCHESTER AVE",
            "address_2": "UVMMC",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054011473",
            "telephone_number": "802-847-2345"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "130 Fisher Rd",
            "address_purpose": "LOCATION",
            "city": "Berlin",
            "state": "VT",
            "postal_code": "056029516",
            "country_code": "US",
            "telephone_number": "802-225-1743",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "77 Plaza Blvd",
            "address_purpose": "LOCATION",
            "city": "Plattsburgh",
            "state": "NY",
            "postal_code": "129016438",
            "country_code": "US",
            "telephone_number": "518-825-4437",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONCHARUK",
        "first_name": "EDWIN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-20",
        "last_updated": "2025-08-27",
        "certification_date": "2025-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VT",
            "license": "032-0133900",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "330524",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "VT",
            "license": "032-0133900",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "VT",
            "license": "032-0133900",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, VT

Sources for this page

Verify at the official NPI Registry.