NPIMap

Individual provider Active NPI

Patrick Anderson, RPA

  • Physician Assistant
  • St Johnsbury, VT
National Provider Identifier
1487640165
Registry record updated Oct 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
055.0031225 Issued in VT
Practice address
185 Sherman Dr
St Johnsbury, VT 05819-9811
Phone
(802) 748-5041
Fax
(802) 748-5094
NPI assigned
Sep 27, 2005
Last updated
Oct 27, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 010315-1 NY
Physician Assistant 363A00000X 055.0031225 VT Primary

Addresses

Primary practice location

185 Sherman Dr
St Johnsbury, VT 05819-9811

Mailing address

165 Sherman Drive
St Johnsbury, VT 05819
Phone (802) 748-9405

Other identifiers 2

IdentifierTypeStateIssuer
02596885MedicaidNY
AA1500OtherNYMEDICARE GROUP ID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150123000356 VT Practitioner - Physician Assistant 6204890494 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Yale University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

165 Sherman Dr
Saint Johnsbury, VT 05819-9811

185 Sherman Dr
Saint Johnsbury, VT 05819-9811
Phone (802) 748-5041

26 Cedar LN
Danville, VT 05828-9751
Phone (802) 684-2275

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
010315-1NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Counties Health Care, Inc. CurrentSince Mar 4, 2020 Accepting new patients
North Country Hospital & Health Center Inc CurrentSince Oct 1, 2014 Accepting new patients
North Country Hospital & Health Center Inc CurrentSince Oct 1, 2014 Accepting new patients
Northern Counties Health Care Inc CurrentSince Mar 4, 2020 Accepting new patients
Northern Counties Health Care Past Accepting new patients

Locations

26 Cedar Ln
Danville, VT 05828
Phone (802) 684-2275

186 Medical Village Dr
Newport, VT 05855
Phone (802) 334-3520

186 Medical Village Dr
#1
Newport, VT 05855
Phone (802) 334-3262

189 Prouty Dr
Newport, VT 05855
Phone (802) 334-3569

165 Sherman Dr
St Johnsbury, VT 05819
Phone (802) 748-9405

185 Sherman Dr
St Johnsbury, VT 05819
Phone (802) 695-2512

Interoperability endpoints

  • Direct secure messaging: patrick.anderson.1@28542.direct.athenahealth.com

Organizations & group practices 5

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.

Hospital & facility affiliations 7

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": "1127779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698364800000",
    "number": "1487640165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 SHERMAN DRIVE",
            "city": "ST JOHNSBURY",
            "state": "VT",
            "postal_code": "05819",
            "telephone_number": "802-748-9405",
            "fax_number": "802-748-4540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 SHERMAN DR",
            "city": "ST JOHNSBURY",
            "state": "VT",
            "postal_code": "058199811",
            "telephone_number": "802-748-5041",
            "fax_number": "802-748-5094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "PATRICK",
        "credential": "RPA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-27",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "010315-1",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VT",
            "license": "055.0031225",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02596885",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP ID",
            "identifier": "AA1500",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Johnsbury, VT

Sources for this page

Verify at the official NPI Registry.