Active NPI
Wallace Hanna Good Jr., M.D.
- Anesthesiology Physician
- Saint Albans, VT
National Provider Identifier
1568496008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 042-0006834
- Practice address
- 12 Lakemount Dr
Saint Albans, VT 05478-0386 - Phone
- (802) 524-5867
- NPI assigned
- Jul 10, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 042-0006834 | VT | Primary |
| Anesthesiology Physician | 207L00000X | 144954 | NY |
Addresses
Primary practice location
12 Lakemount Dr
Saint Albans, VT 05478-0386
Mailing address
PO Box 386
Saint Albans, VT 05478-0386
Phone (802) 452-5817
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0006375 | Medicaid | VT | |
| 06375 | Other | VT | BLUE SHIELD |
| 01053034 | Medicaid | NY | |
| 86095 | Other | VT | MVP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042-0006834 | VT | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Springfield Hospital Inc | Anesthesiology | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Springfield Specialty Physicians
- Anesthesiology Physician
- Springfield, VT
- NPI 1780657783
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1568496008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 386",
"city": "SAINT ALBANS",
"state": "VT",
"postal_code": "054780386",
"telephone_number": "802-452-5817"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 LAKEMOUNT DR",
"city": "SAINT ALBANS",
"state": "VT",
"postal_code": "054780386",
"telephone_number": "802-524-5867"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOOD",
"first_name": "WALLACE",
"middle_name": "HANNA",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "VT",
"license": "042-0006834",
"primary": true
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "NY",
"license": "144954",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0006375",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "06375",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01053034",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP",
"identifier": "86095",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Albans, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.