Ann Marie Gorham, APRN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

1010030543 Issued in VT

Practice address

21 Belmont Ave Ste 1
Brattleboro, VT 05301-6762

Phone

(802) 251-9965

Fax

(802) 257-8834

NPI assigned

Jun 21, 2006

Last updated

Apr 13, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Yale University School of Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brattleboro Memorial HospitalGroup PAC ID 9335112929, 70 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Brattleboro Memorial Hospital Hospital, Brattleboro, VT, CCN 470011

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

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

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.

• Brattleboro Memorial Hospital

  • General Acute Care Hospital
  • Brattleboro, VT
  • NPI 1306849708
  Medicare reassignment Care Compare group NPD
• Brattleboro Emergency Services

  dba Brattleboro Memorial Hospital

  • Emergency Care Clinic/Center
  • Brattleboro, VT
  • NPI 1669532370
  NPD
• Center for Pelvic Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • West Springfield, MA
  • NPI 1043607351
  NPD (past)
• Diabetes and Lifestyle Management, LLC

  • Family Nurse Practitioner
  • Derry, NH
  • NPI 1649649021
  NPD (past)

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

• Brattleboro Memorial Hospital

  • General Acute Care Hospital
  • Brattleboro, VT
  • NPI 1306849708
  Care Compare affiliation

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649808000000",
    "number": "1699711168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 BELMONT AVE",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "05301",
            "telephone_number": "802-251-9965",
            "fax_number": "802-257-8834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 BELMONT AVE STE 1",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "053016762",
            "telephone_number": "802-251-9965",
            "fax_number": "802-257-8834"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17 Belmont Ave Ste 1",
            "address_purpose": "LOCATION",
            "city": "Brattleboro",
            "state": "VT",
            "postal_code": "053013498",
            "country_code": "US",
            "telephone_number": "802-257-0341",
            "fax_number": "802-257-8834",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORHAM",
        "first_name": "ANN MARIE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-21",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VT",
            "license": "1010030543",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MA",
            "license": "RN2269517",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3120196",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6702289",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Brattleboro, VT
• Providers in Brattleboro, VT by specialty
• Nurse Practitioner in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.