NPIMap

Individual provider Active NPI

Eileen Doherty Fuller, MD

  • Family Medicine Physician
  • Middlebury, VT
National Provider Identifier
1679551071
Registry record updated Oct 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
042-007267 Issued in VT
Practice address
1330 Exchange St Ste 201
Middlebury, VT 05753-4464
Phone
(802) 388-1500
Fax
(802) 388-0441
NPI assigned
Jan 5, 2006
Last updated
Oct 14, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 042-007267 VT Primary

Addresses

Primary practice location

1330 Exchange St Ste 201
Middlebury, VT 05753-4464

Mailing address

1330 Exchange St Ste 201
Middlebury, VT 05753-4464
Phone (802) 388-1500

Other identifiers 1

IdentifierTypeStateIssuer
0005628MedicaidVT

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
I20071130000158 VT Practitioner - Family Practice 2466462627 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Vermont College of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Middlebury Family HealthGroup PAC ID 2668482811, 9 clinicians

Practice addresses (Care Compare)

1330 Exchange St
Suite 201
Middlebury, VT 05753-4464
Phone (802) 388-1500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions13

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
042-007267VTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Middlebury Family Health CurrentSince Jul 1, 1983 Accepting new patients

Locations

1330 Exchange St
Ste 201
Middlebury, VT 05753
Phone (802) 388-1500

44 Collins Dr
Ste 201
Middlebury, VT 05753
Phone (802) 388-1500

Interoperability endpoints

  • Direct secure messaging: eileenf@middleburyfamilyhealth.medentdirect.com

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.

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": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602633600000",
    "number": "1679551071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 EXCHANGE ST STE 201",
            "city": "MIDDLEBURY",
            "state": "VT",
            "postal_code": "057534464",
            "telephone_number": "802-388-1500",
            "fax_number": "802-388-0441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 EXCHANGE ST STE 201",
            "city": "MIDDLEBURY",
            "state": "VT",
            "postal_code": "057534464",
            "telephone_number": "802-388-1500",
            "fax_number": "802-388-0441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOHERTY FULLER",
        "first_name": "EILEEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-05",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VT",
            "license": "042-007267",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005628",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Middlebury, VT

Sources for this page

Verify at the official NPI Registry.