Individual provider Active NPI

Diane Tabachnick, PA-C

  • Physician Assistant
  • Burlington, VT
National Provider Identifier
1497875132
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
055-0030969 Issued in VT
Practice address
300 Flynn Ave
Burlington, VT 05401-5301
Phone
(802) 488-6000
Fax
(802) 488-6919
NPI assigned
Mar 29, 2007
Last updated
Apr 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 055-0030969 VT Primary

Addresses

Primary practice location

300 Flynn Ave
Burlington, VT 05401-5301

Mailing address

102 S Winooski Ave
Burlington, VT 05401-7406
Phone (802) 488-6920

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070430000080 VT Practitioner - Physician Assistant 6002879517 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Howard Center IncGroup PAC ID 3072403831, 36 clinicians

Practice addresses (Care Compare)

102 S Winooski Ave
Burlington, VT 05401-7406

300 Flynn Ave
Burlington, VT 05401-5301
Phone (802) 488-6934

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
055-0030969VTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Howard Center Inc CurrentSince Dec 24, 2023 Accepting new patients
Collaborative Solutions Corporation PastSince Jul 9, 2023 Accepting new patients

Locations

208 Flynn Ave
Ste 3J
Burlington, VT 05401
Phone (802) 488-6900

102 S Winooski Ave
Burlington, VT 05401
Phone (802) 488-6920

Organizations & group practices 3

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 1

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": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1497875132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 S WINOOSKI AVE",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054017406",
            "telephone_number": "802-488-6920",
            "fax_number": "802-488-6919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 FLYNN AVE",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054015301",
            "telephone_number": "802-488-6000",
            "fax_number": "802-488-6919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABACHNICK",
        "first_name": "DIANE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VT",
            "license": "055-0030969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, VT

Sources for this page

Verify at the official NPI Registry.