NPIMap

Individual provider Active NPI

Mark C. Bisanzo, MD

  • Emergency Medicine Physician
  • Burlington, VT
National Provider Identifier
1740249226
Registry record updated May 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
222871 Issued in MA
Practice address
111 Colchester Ave.
Uvm Medical Center - Dept. of Surgery/Ed
Burlington, VT 05401
Phone
(802) 847-2434
Fax
(802) 847-4802
NPI assigned
Mar 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 042-0013299 VT
Emergency Medicine Physician 207P00000X 44481 CT
Internal Medicine Physician 207R00000X 222871 MA
Emergency Medicine Physician 207P00000X 222871 MA Primary

Addresses

Primary practice location

111 Colchester Ave.
Uvm Medical Center - Dept. of Surgery/Ed
Burlington, VT 05401

Mailing address

111 Colchester Ave.
Uvm Medical Center - Dept. of Surgery/Ed
Burlington, VT 05401
Phone (802) 847-2434

Other practice location 1

75 Beekman St
Plattsburgh, NY 12901-1438
Phone (518) 561-2000

Other practice location 2

115 Porter Dr
Middlebury, VT 05753-8423
Phone (802) 388-5612

Other identifiers 1

IdentifierTypeStateIssuer
110075594AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160227000169 VT Practitioner - Emergency Medicine 8729082334 Reassigns benefits to 5 organizations
I20200527002281 NY Practitioner - Emergency Medicine 8729082334 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Harvard Medical School, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Vermont Medical Center IncGroup PAC ID 3779491071, 1,208 clinicians

Practice addresses (Care Compare)

111 Colchester Ave
Burlington, VT 05401-1473
Phone (802) 847-0000

Hospital & facility affiliations

  • Univ. of Vermont - Fletcher Allen Health Care Hospital, Burlington, VT, CCN 470003
  • Central Vermont Medical Center Hospital, Barre, VT, CCN 470001
  • Elizabethtown Community Hospital Hospital, Elizabethtown, NY, CCN 331302
  • Porter Hospital Inc Hospital, Middlebury, VT, CCN 471307

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
44481CTMDEmergency Medicine Physician
222871MAMDEmergency Medicine Physician
042-0013299VTMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Elizabethtown Community Hospital CurrentSince Dec 27, 2022 Accepting new patients
Central Vermont Medical Center Inc Internal Medicine CurrentSince Jun 23, 2020 Accepting new patients
Alice Hyde Medical Center Current Accepting new patients
Alice Hyde Medical Center Internal Medicine CurrentSince Dec 26, 2024 Accepting new patients
Porter Hospital Inc Current Accepting new patients
Elizabethtown Community Hospital CurrentSince Dec 27, 2022 Accepting new patients
Central Vermont Medical Center Inc Emergency Medicine CurrentSince Jun 23, 2020 Accepting new patients
University of Vermont Medical Center Inc Emergency Medicine CurrentSince Dec 31, 2015 Accepting new patients
Champlain Valley Physicians Hospital Medical Center Emergency Medicine CurrentSince May 1, 2020 Accepting new patients
Alice Hyde Medical Center Past Accepting new patients
State of Connecticut Emergency Medicine Past Accepting new patients

Locations

969 State Route 11
Moira, NY 12957
Phone (518) 529-7847

75 Beekman St
Plattsburgh, NY 12901
Phone (518) 562-7100

130 Fisher Rd
Barre, VT 05641
Phone (802) 371-4235

130 Fisher Rd
#C
Berlin, VT 05602
Phone (802) 225-5400

111 Colchester Ave
Burlington, VT 05401
Phone (802) 656-2415

1 S Prospect St
Burlington, VT 05401
Phone (802) 847-4531

115 Porter Dr
Middlebury, VT 05753
Phone (802) 388-4701

82 Catamount Park
Middlebury, VT 05753
Phone (802) 388-7185

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/elizabe-e663f886
  • Direct secure messaging: mbisanzo134286@direct.uvmhealth.org

Organizations & group practices 12

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 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": "1142985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590105600000",
    "number": "1740249226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 COLCHESTER AVE.",
            "address_2": "UVM MEDICAL CENTER - DEPT. OF SURGERY/ED",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "05401",
            "telephone_number": "802-847-2434",
            "fax_number": "802-847-4802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 COLCHESTER AVE.",
            "address_2": "UVM MEDICAL CENTER - DEPT. OF SURGERY/ED",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "05401",
            "telephone_number": "802-847-2434",
            "fax_number": "802-847-4802"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "75 Beekman St",
            "address_purpose": "LOCATION",
            "city": "Plattsburgh",
            "state": "NY",
            "postal_code": "129011438",
            "country_code": "US",
            "telephone_number": "518-561-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "115 Porter Dr",
            "address_purpose": "LOCATION",
            "city": "Middlebury",
            "state": "VT",
            "postal_code": "057538423",
            "country_code": "US",
            "telephone_number": "802-388-5612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BISANZO",
        "first_name": "MARK",
        "middle_name": "C.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-22",
        "last_updated": "2020-05-22",
        "certification_date": "2020-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VT",
            "license": "042-0013299",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CT",
            "license": "44481",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "222871",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MA",
            "license": "222871",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110075594A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, VT

Sources for this page

Verify at the official NPI Registry.