NPIMap

Individual provider Active NPI

Richard A Wiseman, MD

  • Internal Medicine Physician
  • Bennington, VT
National Provider Identifier
1730165234
Registry record updated Jun 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
042-0012245 Issued in VT
Practice address
140 Hospital Dr Ste 108
Bennington, VT 05201-5010
Phone
(024) 447-5519
Fax
(802) 447-5657
NPI assigned
Dec 16, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 042-0012245 VT Primary
Internal Medicine Physician 207R00000X 159649 MA

Addresses

Primary practice location

140 Hospital Dr Ste 108
Bennington, VT 05201-5010

Mailing address

140 Hospital Dr Ste 108
Bennington, VT 05201-5010
Phone (802) 447-5519

Other identifiers 2

IdentifierTypeStateIssuer
3195228MedicaidMA
1006998MedicaidVT

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
I20190912001187 VT Practitioner - Internal Medicine 1557253341 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Massachusetts Medical School, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

140 Hospital Dr
Suite 108
Bennington, VT 05201-5010
Phone (802) 447-5519

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
042-0012245VTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southwestern Vermont Medical Center Inc. Internal Medicine CurrentSince Oct 1, 2019 Accepting new patients
North Adams Regional Hospital Current Accepting new patients
Greylock Pathology Partners, LLP Current Accepting new patients

Locations

71 Hospital Ave
North Adams, MA 01247
Phone (413) 664-4343

140 Hospital Dr
Ste 116
Bennington, VT 05201
Phone (802) 447-1836

120 Hospital Dr
Bennington, VT 05201
Phone (802) 440-4077

100 Hospital Dr
Bennington, VT 05201
Phone (802) 447-4509

140 Hospital Dr
Ste 108
Bennington, VT 05201
Phone (802) 447-1191

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 12

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": "1134691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592870400000",
    "number": "1730165234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 HOSPITAL DR STE 108",
            "city": "BENNINGTON",
            "state": "VT",
            "postal_code": "052015010",
            "telephone_number": "802-447-5519",
            "fax_number": "802-447-5657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 HOSPITAL DR STE 108",
            "city": "BENNINGTON",
            "state": "VT",
            "postal_code": "052015010",
            "telephone_number": "024-447-5519",
            "fax_number": "802-447-5657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISEMAN",
        "first_name": "RICHARD",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-16",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VT",
            "license": "042-0012245",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "159649",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3195228",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1006998",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bennington, VT

Sources for this page

Verify at the official NPI Registry.