NPIMap

Individual provider Active NPI

David McCormack

  • Family Nurse Practitioner
  • Brattleboro, VT
National Provider Identifier
1619420346
Registry record updated Jul 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
101.0122031 Issued in VT
Practice address
53 Fairview St
Brattleboro, VT 05301
Phone
(802) 251-8455
NPI assigned
Jul 29, 2016
Last updated
Jul 29, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 29, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 101.0122031 VT Primary

Addresses

Primary practice location

53 Fairview St
Brattleboro, VT 05301

Mailing address

56 Loop Rd
Newfane, VT 05345

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
I20160922001605 VT Practitioner - Nurse Practitioner 6002103843 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
May accept Medicare assignment
Group practices
Carlos G Otis Health Care Center IncGroup PAC ID 6002726387, shared by 4 NPIs, 46 clinicians

Practice addresses (Care Compare)

185 Grafton Rd
Townshend, VT 05353-8820
Phone (802) 365-3601

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
101.0122031VTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Carlos G Otis Health Care Center Inc CurrentSince May 21, 2018 Accepting new patients
Carlos G Otis Health Care Center Inc CurrentSince May 21, 2018 Accepting new patients
Carlos G. Otis Health Care Center Inc. CurrentSince Dec 1, 2025 Accepting new patients
Brattleboro Memorial Hospital CurrentSince Aug 1, 2016 Accepting new patients
Dartmouth-Hitchcock Clinic PastSince Aug 1, 2016 Accepting new patients

Locations

17 Belmont Ave
Brattleboro, VT 05301
Phone (802) 257-8360

53 Fairview St
Brattleboro, VT 05301
Phone (802) 251-8455

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/d9dc001d-1bc5-42f9-bd4d-eb79208fd32a/

Organizations & group practices 5

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 8

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": "1469750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469750400000",
    "number": "1619420346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56 LOOP RD",
            "city": "NEWFANE",
            "state": "VT",
            "postal_code": "05345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 FAIRVIEW ST",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "05301",
            "telephone_number": "802-251-8455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMACK",
        "first_name": "DAVID",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-29",
        "last_updated": "2016-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VT",
            "license": "101.0122031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brattleboro, VT

Sources for this page

Verify at the official NPI Registry.