NPIMap

Individual provider Active NPI

Clayton Ross Wilburn, M.D.

  • Clinical Pathology Physician
  • Burlington, VT
National Provider Identifier
1609130681
Registry record updated Jan 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Pathology PhysicianTaxonomy code 207ZC0006X
License
15-541 Issued in TX
Practice address
111 Colchester Ave
Burlington, VT 05401-1473
Phone
(802) 847-9657
Fax
(802) 847-3509
NPI assigned
Jun 25, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Pathology Physician 207ZC0006X 15-541 TX Primary

Addresses

Primary practice location

111 Colchester Ave
Burlington, VT 05401-1473

Mailing address

4 Common Rd
Westford, VT 05494-9721
Phone (615) 636-6622

Other identifiers 1

IdentifierTypeStateIssuer
567339OtherTXTEXAS MEDICAL BOARD

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
I20170626000571 VT Practitioner - Pathology 4688942147 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

111 Colchester Ave
Burlington, VT 05401-1473
Phone (802) 847-0000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15-541TXMDClinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Vermont Medical Center Inc CurrentSince Sep 1, 2020 Accepting new patients
Central Vermont Medical Center Inc CurrentSince Sep 1, 2020 Accepting new patients
University of Vermont Medical Center Inc CurrentSince May 15, 2017 Accepting new patients

Locations

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

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

111 Colchester Ave
Burlington, VT 05401
Phone (802) 656-2415

1 S Prospect St
Burlington, VT 05401
Phone (802) 847-4531

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 and National Provider Directory roles.

Hospital & facility affiliations 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1340582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548633600000",
    "number": "1609130681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 COMMON RD",
            "city": "WESTFORD",
            "state": "VT",
            "postal_code": "054949721",
            "telephone_number": "615-636-6622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 COLCHESTER AVE",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054011473",
            "telephone_number": "802-847-9657",
            "fax_number": "802-847-3509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBURN",
        "first_name": "CLAYTON",
        "middle_name": "ROSS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-25",
        "last_updated": "2019-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZC0006X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology",
            "state": "TX",
            "license": "15-541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS MEDICAL BOARD",
            "identifier": "567339",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, VT

Sources for this page

Verify at the official NPI Registry.