Adisa Ratanasirintrawoot

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

016.0134058 Issued in VT

Practice address

1775 Williston Rd
South Burlington, VT 05403-6491

Phone

(802) 863-5447

NPI assigned

Oct 18, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: aratanasirintrawoot507115@direct.uvmhealth.org

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

{
    "created_epoch": "1539820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632787200000",
    "number": "1619443546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 PINE ST APT 509",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054015945",
            "telephone_number": "857-361-2255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 WILLISTON RD",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054036491",
            "telephone_number": "802-863-5447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RATANASIRINTRAWOOT",
        "first_name": "ADISA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-18",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "VT",
            "license": "016.0134058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Marie Rancourt, MS, RDN, CD
• Courtneyanne Randall, PA-C
• Tana V Randall, LICSW
• Chelsea Rapin, DPT
• Shanna Rapp, PHARMD
• Kassidy Reed, DPT
• Regional Home Care Inc
• Aaron W Reiter, M.D.
• Tiffany Renaud, D.C.
• Retina Center of Vermont, Inc

• Periodontics in South Burlington, VT
• Providers in South Burlington, VT by specialty
• Periodontics in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.