Active NPI
Wynne M Kirschbaum, PA
- Physician Assistant
- Colchester, VT
National Provider Identifier
1386859890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0550030813
- Practice address
- 792 College Pkwy
Suite302
Colchester, VT 05446-3052 - Phone
- (802) 655-4900
- Fax
- (802) 655-5017
- NPI assigned
- May 10, 2007
- Last updated
- Feb 1, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0550030813 | VT | Primary |
| Surgical Physician Assistant | 363AS0400X | 0550030813 | VT |
Addresses
Primary practice location
792 College Pkwy
Suite302
Colchester, VT 05446-3052
Mailing address
792 College Pkwy
Suite302
Colchester, VT 05446-3052
Phone (802) 655-4900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9000350 | Medicaid | VT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0550030813 | VT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thoracic & Cardiovascular Surgeons LLC | Past | Accepting new patients |
Interoperability endpoints
- wynne.kirschbaum@hca4.eclinicaldirectplus.com
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- NPI 1649212416
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201824000000",
"number": "1386859890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "792 COLLEGE PKWY",
"address_2": "SUITE302",
"city": "COLCHESTER",
"state": "VT",
"postal_code": "054463052",
"telephone_number": "802-655-4900",
"fax_number": "802-655-5017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "792 COLLEGE PKWY",
"address_2": "SUITE302",
"city": "COLCHESTER",
"state": "VT",
"postal_code": "054463052",
"telephone_number": "802-655-4900",
"fax_number": "802-655-5017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRSCHBAUM",
"first_name": "WYNNE",
"middle_name": "M",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-10",
"last_updated": "2008-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VT",
"license": "0550030813",
"primary": true
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "VT",
"license": "0550030813",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9000350",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Colchester, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.