NPIMap

Individual provider Active NPI

Andrea Leigh Decker

  • Physician Assistant
  • Burlington, VT
National Provider Identifier
1366476400
Registry record updated Dec 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
55-0030650 Issued in VT
Practice address
111 Colchester Ave
Fahc Emergency Department
Burlington, VT 05401-1473
Phone
(802) 847-1237
Fax
(802) 847-5963
NPI assigned
Jul 11, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 20, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 026780 NY
Physician Assistant 363A00000X 55-0030650 VT Primary

Addresses

Primary practice location

111 Colchester Ave
Fahc Emergency Department
Burlington, VT 05401-1473

Mailing address

129 Cobblestone Cir
South Burlington, VT 05403-7606

Other practice location 1

75 Beekman St
Plattsburgh, NY 12901-1438
Phone (518) 562-7371

Other identifiers 1

IdentifierTypeStateIssuer
9000163MedicaidVT

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
I20070926000077 VT Practitioner - Physician Assistant 7911091665 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Vermont Medical Center Inc 1,208 clinicians

Practice addresses (Care Compare)

1 S Prospect St
Burlington, VT 05401-3456
Phone (802) 847-0000

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

790 College Pkwy
Colchester, VT 05446-3007
Phone (802) 847-0000

Hospital & facility affiliations

  • Univ. of Vermont - Fletcher Allen Health Care Hospital, Burlington, VT, CCN 470003

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
55-0030650VTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Center, Inc CurrentSince Mar 7, 2024 Accepting new patients
University of Vermont Medical Center Inc CurrentSince Sep 4, 2003 Accepting new patients
Northwestern Medical Center Inc CurrentSince Mar 7, 2024 Accepting new patients
University of Vermont Medical Center Inc Past Accepting new patients
Clearchoicemd Primary Care PLLC Past Accepting new patients

Locations

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

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

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

790 College Pkwy
#2
Colchester, VT 05446

160 Allen St
Rutland, VT 05701

133 Fairfield St
Saint Albans, VT 05478
Phone (802) 524-1227

Interoperability endpoints

  • Direct secure messaging: adecker7438@direct.uvmhealth.org

Organizations & group practices 17

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.

View all 17

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": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639958400000",
    "number": "1366476400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 COBBLESTONE CIR",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 COLCHESTER AVE",
            "address_2": "FAHC EMERGENCY DEPARTMENT",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054011473",
            "telephone_number": "802-847-1237",
            "fax_number": "802-847-5963"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "75 Beekman St",
            "address_purpose": "LOCATION",
            "city": "Plattsburgh",
            "state": "NY",
            "postal_code": "129011438",
            "country_code": "US",
            "telephone_number": "518-562-7371",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DECKER",
        "first_name": "ANDREA",
        "middle_name": "LEIGH",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "026780",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VT",
            "license": "55-0030650",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000163",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, VT

Sources for this page

Verify at the official NPI Registry.