NPIMap

Individual provider Active NPI

Kelvey Richards Wilson, M.D.

  • Emergency Medicine Physician
  • Berlin, VT
National Provider Identifier
1487828547
Registry record updated May 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
042.0012164 Issued in VT
Practice address
130 Fisher Rd
Berlin, VT 05602-9516
Phone
(802) 371-4263
Fax
(802) 371-4481
NPI assigned
Apr 18, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 042.0012164 VT Primary

Addresses

Primary practice location

130 Fisher Rd
Berlin, VT 05602-9516

Mailing address

PO Box 547
Att: CVMC Finance Dept
Barre, VT 05641-0547
Phone (802) 371-4263

Other identifiers 2

IdentifierTypeStateIssuer
1019211MedicaidVT
002401601OtherVTMEDICARE PTAN LINKED TO CVMC

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
I20111025000559 VT Practitioner - Emergency Medicine 6608049325 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Vermont Medical Center IncGroup PAC ID 9335138817, shared by 4 NPIs, 233 clinicians

Practice addresses (Care Compare)

130 Fisher Rd
Barre, VT 05641-9004
Phone (802) 371-4235

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Central Vermont Medical Center Inc Emergency Medicine Current Accepting new patients
Copley Hospital Inc Current Accepting new patients
Copley Hospital, Inc. Current Accepting new patients
Copley Hospital, Inc. Current Accepting new patients
Central Vermont Medical Center Inc CurrentSince Jul 1, 2011 Accepting new patients
Copley Hospital, Inc. CurrentSince Jan 1, 2018 Accepting new patients
Copley Hospital, Inc CurrentSince Jan 1, 2018 Accepting new patients
Copley Hospital, Inc. Current Accepting new patients

Locations

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

130 Fisher Rd
#C
Berlin, VT 05602
Phone (802) 225-5400

528 Washington Hwy
Morrisville, VT 05661
Phone (802) 888-4231

Interoperability endpoints

  • Direct secure messaging: kwilson72585@direct.uvmhealth.org

Organizations & group practices 8

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 2

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": "1208476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399248000000",
    "number": "1487828547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 547",
            "address_2": "ATT: CVMC FINANCE DEPT",
            "city": "BARRE",
            "state": "VT",
            "postal_code": "056410547",
            "telephone_number": "802-371-4263",
            "fax_number": "802-371-4481"
        },
        {
            "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": "802-371-4263",
            "fax_number": "802-371-4481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KELVEY",
        "middle_name": "RICHARDS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-18",
        "last_updated": "2014-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VT",
            "license": "042.0012164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1019211",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN LINKED TO CVMC",
            "identifier": "002401601",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berlin, VT

Sources for this page

Verify at the official NPI Registry.