NPIMap

Individual provider Active NPI

Jennifer R Wisdom-Behounek, MD

  • Family Medicine Physician
  • Bristol, VT
National Provider Identifier
1497858278
Registry record updated Feb 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2009005696 Issued in MO
Practice address
61 Pine St BLDG 4
Bristol, VT 05443-1043
Phone
(573) 884-7733
NPI assigned
Sep 6, 2006
Last updated
Feb 22, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2009005696 MO Primary
Family Medicine Physician 207Q00000X T2006017329 MO

Addresses

Primary practice location

61 Pine St BLDG 4
Bristol, VT 05443-1043

Mailing address

61 Pine St BLDG 4
Bristol, VT 05443-1043

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
I20201015003107 VT Practitioner - Family Practice 6305991290 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Five-Town Health Alliance, IncGroup PAC ID 9638321342, 10 clinicians

Practice addresses (Care Compare)

61 Pine St
Bristol, VT 05443-1043
Phone (802) 453-6843

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2009005696MOMDFamily Medicine Physician
T2006017329MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Five-Town Health Alliance, Inc CurrentSince Sep 15, 2020 Accepting new patients
Five-Town Health Alliance, Inc Family Medicine CurrentSince Sep 15, 2020 Accepting new patients

Locations

61 Pine St
Bristol, VT 05443
Phone (802) 453-3911

61 Pine St
Bldg 4
Bristol, VT 05443
Phone (802) 453-3911

Organizations & group practices 2

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 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645488000000",
    "number": "1497858278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 PINE ST BLDG 4",
            "city": "BRISTOL",
            "state": "VT",
            "postal_code": "054431043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 PINE ST BLDG 4",
            "city": "BRISTOL",
            "state": "VT",
            "postal_code": "054431043",
            "telephone_number": "573-884-7733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISDOM-BEHOUNEK",
        "first_name": "JENNIFER",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-06",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2009005696",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "T2006017329",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, VT

Sources for this page

Verify at the official NPI Registry.