Active NPI
Kenneth Elliot Adler, MD
- Psychiatry Physician
- Berlin, VT
National Provider Identifier
1417976887
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 042-0009896
- Practice address
- 130 Fisher Rd
Berlin, VT 05602-9516 - Phone
- (802) 371-4100
- NPI assigned
- Jul 18, 2006
- Last updated
- Dec 9, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 042-0009896 | VT | Primary |
Addresses
Primary practice location
130 Fisher Rd
Berlin, VT 05602-9516
Mailing address
130 Fisher Rd
PO Box 547
Berlin, VT 05602-9516
Phone (802) 371-4100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OVN2041 | 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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042-0009896 | VT | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Matrix Health Systems P.C. | Past | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Clinical Psychologist
- Burlington, VT
- NPI 1104872712
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260316800000",
"number": "1417976887",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 FISHER RD",
"address_2": "PO BOX 547",
"city": "BERLIN",
"state": "VT",
"postal_code": "056029516",
"telephone_number": "802-371-4100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 FISHER RD",
"city": "BERLIN",
"state": "VT",
"postal_code": "056029516",
"telephone_number": "802-371-4100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ADLER",
"first_name": "KENNETH",
"middle_name": "ELLIOT",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-18",
"last_updated": "2009-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "VT",
"license": "042-0009896",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "OVN2041",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Berlin, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.