Active NPI
Vashti McCormick
- Registered Nurse
- Saranac Lake, NY
National Provider Identifier
1407399520
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 806814
- Practice address
- 70 Edgewood Rd
Saranac Lake, NY 12983-1537 - Phone
- (518) 891-5535
- NPI assigned
- Nov 21, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 10325614 | NY | |
| Licensed Practical Nurse | 164W00000X | 325614 | NY | |
| Registered Nurse | 163W00000X | 806814 | NY | Primary |
Addresses
Primary practice location
70 Edgewood Rd
Saranac Lake, NY 12983-1537
Mailing address
14 Vachereau St
Tupper Lake, NY 12986-1817
Other practice location 1
755 County Route 18
Lake Clear, NY 12945-1816
Phone (518) 637-6611
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 806814 | NY | MD | Registered Nurse |
| 10325614 | NY | MD | Licensed Practical Nurse |
| 325614 | NY | MD | Licensed Practical Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Citizen Advocates, Inc | Current | Accepting new patients |
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 and National Provider Directory roles.
-
- Substance Use Disorder Rehabilitation Clinic/Center
- Malone, NY
- NPI 1780619064
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1479686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672704000000",
"number": "1407399520",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 VACHEREAU ST",
"city": "TUPPER LAKE",
"state": "NY",
"postal_code": "129861817"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "70 EDGEWOOD RD",
"city": "SARANAC LAKE",
"state": "NY",
"postal_code": "129831537",
"telephone_number": "518-891-5535"
}
],
"practiceLocations": [
{
"address_1": "755 County Route 18",
"address_purpose": "LOCATION",
"city": "Lake Clear",
"state": "NY",
"postal_code": "129451816",
"country_code": "US",
"telephone_number": "518-637-6611",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MCCORMICK",
"first_name": "VASHTI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-11-21",
"last_updated": "2023-01-03",
"certification_date": "2023-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "10325614",
"primary": false
},
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "325614",
"primary": false
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "806814",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Saranac Lake, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.