NPIMap

Individual provider Active NPI

Daniel Wilson, DO

  • Emergency Medicine Physician
  • Berlin, VT
National Provider Identifier
1437179074
Registry record updated Jun 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
032-0000500 Issued in VT
Practice address
130 Fisher Rd
Berlin, VT 05602-9516
Phone
(802) 371-4100
NPI assigned
Jul 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 032-0000500 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

IdentifierTypeStateIssuer
OVN2743MedicaidVT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT, MA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080714000362 VT Practitioner - Emergency Medicine 5799858403 Reassigns benefits to 2 organizations
I20160405000551 MA Practitioner - Emergency Medicine 5799858403 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
West Virginia School of Osteopathic Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Heywood Memorial HospitalGroup PAC ID 1658262605, 116 clinicians

Practice addresses (Care Compare)

2033 Main St
Athol, MA 01331-3535
Phone (978) 249-3511

242 Green St
Gardner, MA 01440-1336
Phone (978) 632-3420

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
82.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Athol Memorial Hospital Incorporated Emergency Medicine CurrentSince Mar 1, 2016 Accepting new patients
Central Vermont Medical Center Inc CurrentSince Dec 3, 2001 Accepting new patients
Northeastern Vermont Regional Hospital Inc Current Accepting new patients
Northeastern Vermont Regional Hospital, Inc Current Accepting new patients
Northeastern Vermont Regional Hospital, Inc Current Accepting new patients
Central Vermont Medical Center Inc Emergency Medicine CurrentSince Dec 3, 2001 Accepting new patients
Northeastern Vermont Regional Hospital, Inc Current Accepting new patients
Northeastern Vermont Regional Hospital Inc. CurrentSince Mar 9, 2016 Accepting new patients
Henry Heywood Memorial Hospital Emergency Medicine CurrentSince Mar 1, 2016 Accepting new patients
Henry Heywood Memorial Hospital CurrentSince Mar 1, 2016 Accepting new patients
Northeastern Vermont Regional Hospital, Inc CurrentSince Mar 9, 2016 Accepting new patients

Locations

2033 Main St
Athol, MA 01331
Phone (978) 249-1295

242 Green St
Gardner, MA 01440
Phone (978) 258-4734

130 Fisher Rd
Barre, VT 05641
Phone (802) 371-4235

77 Vine St
Barre, VT 05641
Phone (802) 225-1266

130 Fisher Rd
Berlin, VT 05602
Phone (802) 225-5820

1315 Hospital Dr
St Johnsbury, VT 05819
Phone (802) 748-3638

Organizations & group practices 11

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308355200000",
    "number": "1437179074",
    "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": "WILSON",
        "first_name": "DANIEL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2011-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VT",
            "license": "032-0000500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OVN2743",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berlin, VT

Sources for this page

Verify at the official NPI Registry.