Marjorie Nikki Gewirz, PA-C
Individual provider Active NPI Physician Assistant · Randolph, VT
NPI 1720021918 · NPPES record last updated Oct 30, 2023
Key facts
- NPI
- 1720021918
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 055-0030993 (VT)
- Practice address
- 44 S Main St
Surgical Associates
Randolph, VT 05060-1381 - Phone
- (802) 728-2372
- Fax
- (802) 728-2613
- NPI assigned
- Jun 14, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Eon Care Clinicians PC
Practice addresses (Care Compare)
217 Maxham Meadow Way
Suite 3a
Woodstock, VT 05091-1162
Phone (240) 778-6164
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NH, VT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060418000448 | NH | Practitioner - Physician Assistant | 7416966577 | |
| I20091106000019 | VT | Practitioner - Physician Assistant | 7416966577 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0581 | NH | MD | Occupational Therapy Assistant |
| 055-0030993 | VT | MD | Physician Assistant |
| 055-0031029 | VT | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Woodstock Health Clinic PLLC | Physician Assistant | Current |
Accepting new patients |
| Eon Care Clinicians PC | Current |
Accepting new patients | |
| Gifford Medical Center Inc. | Current |
Accepting new patients | |
| Porter Hospital, Inc | Current |
Accepting new patients | |
| Total Wellness Centers, LLC | Past | Accepting new patients |
Locations
20451 Seneca Meadows Pkwy
Germantown, MD 20876
Phone (301) 515-2760
104 Porter Dr
Middlebury, VT 05753
Phone (802) 388-5682
82 Catamount Park
Middlebury, VT 05753
Phone (802) 388-7185
44 S Main St
Randolph, VT 05060
Phone (802) 728-4441
10 North St
Vergennes, VT 05491
Phone (802) 877-3466
217 Maxham Meadow Way
Ste 3A
Woodstock, VT 05091
Phone (802) 324-1281
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 0581 | NH | |
| Surgical Physician Assistant | 363AS0400X | 055-0031029 | VT | |
| Surgical Physician Assistant | 363AS0400X | 055-0030993 | VT | |
| Physician Assistant | 363A00000X | 055-0030993 | VT | Yes |
Addresses
Primary practice location
44 S Main St
Surgical Associates
Randolph, VT 05060-1381
Mailing address
44 S Main St
Surgical Associates
Randolph, VT 05060-1381
Phone (802) 728-2372
Other practice location 1
10 North St
Vergennes, VT 05491-1107
Phone (802) 877-3466
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0013358 | Other | VT | MEDICARE PTAN |
| 9000284 | Medicaid | VT |
Other providers in Randolph, VT
- Jordan Galluzzo
- Lyndsay Galluzzo
- Hannah Bell Geldermann
- Alicia E Gelfant
- Margaret Gerrish
- Gifford Health Care, Inc
- Gifford Health Care, Inc
- Gifford Health Care, Inc
- Gifford Health Care, Inc
- Gifford Health Care, Inc.
All providers in Randolph, VT · Physician Assistant in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.