NPIMap

Organization Active NPI

Border Pediatrics

  • Pediatric Adolescent Medicine Physician
  • Derby Line, VT
National Provider Identifier
1750483780
Registry record updated Jan 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
042-0008370 Issued in VT
Legal business name
BORDER PEDIATRICS
Practice address
159 Main St
Derby Line, VT 05830-8754
Phone
(802) 873-3009
Fax
(802) 873-3176
NPI assigned
Sep 1, 2006
Last updated
Jan 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2013

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

Authorized official

Name
Dr. Miriam Blodgett Tatum, M.D.NPI 1770682106
Title
President
Phone
(802) 873-3009

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 042-0008363 VT
Pediatric Adolescent Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080A0000X 042-0008370 VT Primary

Addresses

Primary practice location

159 Main St
Derby Line, VT 05830-8754

Mailing address

159 Main St
Derby Line, VT 05830-8754
Phone (802) 873-3009

Other names 1

  • Border Health Center Former legal business name

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14688/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357257600000",
    "number": "1750483780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 MAIN ST",
            "city": "DERBY LINE",
            "state": "VT",
            "postal_code": "058308754",
            "telephone_number": "802-873-3009",
            "fax_number": "802-873-3176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 MAIN ST",
            "city": "DERBY LINE",
            "state": "VT",
            "postal_code": "058308754",
            "telephone_number": "802-873-3009",
            "fax_number": "802-873-3176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BORDER PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-01",
        "last_updated": "2013-01-04",
        "status": "A",
        "authorized_official_last_name": "TATUM",
        "authorized_official_first_name": "MIRIAM",
        "authorized_official_middle_name": "BLODGETT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "802-873-3009",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "VT",
            "license": "042-0008363",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "VT",
            "license": "042-0008370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Border Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Derby Line, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.