Active NPI
Stuart Michael Duboff, M.D.
- Ophthalmology Physician
- Bennington, VT
National Provider Identifier
1417901356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 042-0005399
- Practice address
- 322 Dewey St
Bennington, VT 05201-2225 - Phone
- (802) 447-8700
- Fax
- (802) 447-1500
- NPI assigned
- May 22, 2006
- Last updated
- Mar 30, 2018
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 37276 | MA | |
| Ophthalmology Physician | 207W00000X | 042-0005399 | VT | Primary |
Addresses
Primary practice location
322 Dewey St
Bennington, VT 05201-2225
Mailing address
322 Dewey St
Bennington, VT 05201-2225
Phone (802) 447-8700
Other identifiers 16
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10000532 | Other | MA | CDPHP |
| VT0005994 | Other | VT | TRICARE |
| VT4364 | Other | VT | VTBS |
| 11962 | Other | VT | HNE |
| VT4364 | Other | MA | VTBS |
| 000000024103 | Other | MA | BMC |
| 0004364 | Medicaid | VT | |
| 00360054 | Medicaid | NY | |
| 10000532 | Other | VT | CDPHP |
| 11962 | Other | MA | HNE |
| I19049 | Other | MA | MABS |
| 000000024104 | Other | VT | BMC |
| 17154 | Other | MA | MVP |
| I19049 | Other | VT | MABS |
| 110000245A | Medicaid | MA | |
| 17154 | Other | VT | MVP |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042-0005399 | VT | MD | Ophthalmology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Williamstown Medical Associates PC | Past | Accepting new patients | |
| Cataract and Laser Center Associates PC | Past | Accepting new patients |
Organizations & group practices 2
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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- Adams, MA
- NPI 1477655801
-
- Internal Medicine Physician
- Williamstown, MA
- NPI 1154319200
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522368000000",
"number": "1417901356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "322 DEWEY ST",
"city": "BENNINGTON",
"state": "VT",
"postal_code": "052012225",
"telephone_number": "802-447-8700",
"fax_number": "802-447-1500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "322 DEWEY ST",
"city": "BENNINGTON",
"state": "VT",
"postal_code": "052012225",
"telephone_number": "802-447-8700",
"fax_number": "802-447-1500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUBOFF",
"first_name": "STUART",
"middle_name": "MICHAEL",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-22",
"last_updated": "2018-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "MA",
"license": "37276",
"primary": false
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "VT",
"license": "042-0005399",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CDPHP",
"identifier": "10000532",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "VT0005994",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VTBS",
"identifier": "VT4364",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HNE",
"identifier": "11962",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VTBS",
"identifier": "VT4364",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BMC",
"identifier": "000000024103",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0004364",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00360054",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CDPHP",
"identifier": "10000532",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HNE",
"identifier": "11962",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MABS",
"identifier": "I19049",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BMC",
"identifier": "000000024104",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP",
"identifier": "17154",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MABS",
"identifier": "I19049",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110000245A",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP",
"identifier": "17154",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bennington, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.