NPIMap

Organization Active NPI

Pediatric Medicine, PLC

  • Pediatrics Physician
  • South Burlington, VT
National Provider Identifier
1487701140
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRIC MEDICINE, PLC
Practice address
52 Timber LN
South Burlington, VT 05403-7204
Phone
(802) 864-5004
Fax
(802) 863-6933
NPI assigned
Jan 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Lisa Renee Bushee
Title
Business Manager
Phone
(802) 864-5004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

52 Timber LN
South Burlington, VT 05403-7204

Mailing address

52 Timber LN
South Burlington, VT 05403-7204
Phone (802) 864-5004

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
47D0091266Pediatric Medicine PLC52 Timber LN, South Burlington, VT 05403ComplianceNov 14, 2026

National Provider Directory

National Provider Directory

Locations

52 Timber Ln
South Burlington, VT 05403
Phone (802) 658-2320

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487701140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 TIMBER LN",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037204",
            "telephone_number": "802-864-5004",
            "fax_number": "802-863-6933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 TIMBER LN",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037204",
            "telephone_number": "802-864-5004",
            "fax_number": "802-863-6933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC MEDICINE, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BUSHEE",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "802-864-5004",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Burlington, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.