NPIMap

Organization Active NPI

Northwestern Medical Center, Inc.

Doing business as Northwestern Primary Care

  • Family Medicine Physician
  • Saint Albans, VT
National Provider Identifier
1417274663
Registry record updated Aug 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
NORTHWESTERN MEDICAL CENTER, INC.
Doing business as
Northwestern Primary Care
Practice address
260 Crest Rd
Saint Albans, VT 05478-9503
Phone
(802) 524-8805
Fax
(802) 524-8488
NPI assigned
Apr 28, 2010
Last updated
Aug 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2021

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

Authorized official

Name
Mary Pigeon
Title
Credentialing Specialist
Phone
(802) 524-8954

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

260 Crest Rd
Saint Albans, VT 05478-9503

Mailing address

133 Fairfield St
Saint Albans, VT 05478-1726
Phone (802) 524-5911

Other identifiers 1

IdentifierTypeStateIssuer
1017547MedicaidVT

Other names 1

  • Northwestern Primary Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Northwestern Medical Ce36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

Organizations that report the same tax identification number in the National Provider Directory.

View all 35

Locations

133 Fairfield St
Ste 103
Saint Albans, VT 05478
Phone (802) 524-8805

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1272412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1417274663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 FAIRFIELD ST",
            "city": "SAINT ALBANS",
            "state": "VT",
            "postal_code": "054781726",
            "telephone_number": "802-524-5911",
            "fax_number": "802-527-1057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 CREST RD",
            "city": "SAINT ALBANS",
            "state": "VT",
            "postal_code": "054789503",
            "telephone_number": "802-524-8805",
            "fax_number": "802-524-8488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWESTERN MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-28",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A",
        "authorized_official_last_name": "PIGEON",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "802-524-8954"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1017547",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwestern Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Albans, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.