Individual provider Active NPI

Spencer Ciancola

  • Physician Assistant
  • Bennington, VT
National Provider Identifier
1285295154
Registry record updated Dec 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
055.0031452 Issued in VT
Practice address
140 Hospital Dr Ste 111
Bennington, VT 05201-5010
Phone
(802) 440-4077
NPI assigned
Jun 21, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 055.0031452 VT Primary

Addresses

Primary practice location

140 Hospital Dr Ste 111
Bennington, VT 05201-5010

Mailing address

100 Hospital Dr
Bennington, VT 05201-5004

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200319000687 VT Practitioner - Physician Assistant 4688002918 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southwestern Vermont Medical Center, IncGroup PAC ID 0143138446, 174 clinicians

Practice addresses (Care Compare)

140 Hospital Dr
Bennington, VT 05201-5010

140 Hospital Dr
Bennington, VT 05201-5018

Hospital & facility affiliations

  • Southwestern Vermont Medical Center Hospital, Bennington, VT, CCN 470012

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southwestern Vermont Medical Center Inc. CurrentSince Apr 1, 2020 Accepting new patients
Southwestern Vermont Medical Center Inc. CurrentSince Apr 1, 2020 Accepting new patients
Southwestern Vermont Medical Center, Inc Past Accepting new patients

Locations

100 Hospital Dr
Bennington, VT 05201
Phone (802) 447-4509

120 Hospital Dr
Bennington, VT 05201
Phone (802) 440-4077

100 Hospital Dr
#44
Bennington, VT 05201
Phone (802) 442-4509

140 Hospital Dr
Ste 116
Bennington, VT 05201
Phone (802) 447-1836

140 Hospital Dr
Ste 111
Bennington, VT 05201
Phone (719) 362-7244

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1561075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640476800000",
    "number": "1285295154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL DR",
            "city": "BENNINGTON",
            "state": "VT",
            "postal_code": "052015004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 HOSPITAL DR STE 111",
            "city": "BENNINGTON",
            "state": "VT",
            "postal_code": "052015010",
            "telephone_number": "802-440-4077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIANCOLA",
        "first_name": "SPENCER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-21",
        "last_updated": "2021-12-26",
        "certification_date": "2021-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VT",
            "license": "055.0031452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bennington, VT

Sources for this page

Verify at the official NPI Registry.