NPIMap

Organization Active NPI

Four Seasons Dermatology LLC

  • Dermatology Physician
  • Colchester, VT
National Provider Identifier
1790737393
Registry record updated Apr 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
FOUR SEASONS DERMATOLOGY LLC
Practice address
354 Mountain View Drive
Suite 300
Colchester, VT 05446-5988
Phone
(802) 864-0192
Fax
(802) 860-4919
NPI assigned
May 16, 2006
Last updated
Apr 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2022

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

Authorized official

Name
Dr. Steven Robert Partilo, MDNPI 1326016742
Title
Member
Phone
(802) 864-0192

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary
Orthopaedic Hand Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XS0106X
Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208200000X

Addresses

Primary practice location

354 Mountain View Drive
Suite 300
Colchester, VT 05446-5988

Mailing address

354 Mountain View Drive
Suite 300
Colchester, VT 05446-5988
Phone (802) 864-0192

Other practice location 1

110 Porter Dr
Middlebury, VT 05753-8527
Phone (802) 864-0192

Other practice location 2

28 Stowe St Ste 3
Waterbury, VT 05676-1883
Phone (802) 864-0192

Other practice location 3

2 Healey Ave
Plattsburgh, NY 12901-2413
Phone (802) 864-0192

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040824001173 VT Part B Supplier - Clinic/Group Practice 8820062946 Receives reassigned benefits from 20 practitioners
Practice locations: Colchester, VT; Middlebury, VT; Shelburne, VT; Waterbury, VT

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2170852Four Seasons Dermatology LLC2 Healey Avenue, Plattsburgh, NY 12901Provider-performed microscopyAug 20, 2027
47D2218980Four Seasons Dermatology28 Stowe St, Ste 3, Waterbury, VT 05676Provider-performed microscopyMar 31, 2027

National Provider Directory

National Provider Directory

Locations

2 Healey Ave
Plattsburgh, NY 12901
Phone (518) 561-2225

200 Wake Robin Dr
Shelburne, VT 05482
Phone (802) 264-5139

366 Dorset St
Ste 2
South Burlington, VT 05403

368 Dorset St
Ste 2
South Burlington, VT 05403
Phone (802) 860-7070

Practitioners & affiliated clinicians

Practitioners 25

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.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651104000000",
    "number": "1790737393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "354 MOUNTAIN VIEW DRIVE",
            "address_2": "SUITE 300",
            "city": "COLCHESTER",
            "state": "VT",
            "postal_code": "054465988",
            "telephone_number": "802-864-0192",
            "fax_number": "802-860-4919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 MOUNTAIN VIEW DRIVE",
            "address_2": "SUITE 300",
            "city": "COLCHESTER",
            "state": "VT",
            "postal_code": "054465988",
            "telephone_number": "802-864-0192",
            "fax_number": "802-860-4919"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 Porter Dr",
            "address_purpose": "LOCATION",
            "city": "Middlebury",
            "state": "VT",
            "postal_code": "057538527",
            "country_code": "US",
            "telephone_number": "802-864-0192",
            "fax_number": "802-860-4919",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "28 Stowe St Ste 3",
            "address_purpose": "LOCATION",
            "city": "Waterbury",
            "state": "VT",
            "postal_code": "056761883",
            "country_code": "US",
            "telephone_number": "802-864-0192",
            "fax_number": "802-860-4919",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2 Healey Ave",
            "address_purpose": "LOCATION",
            "city": "Plattsburgh",
            "state": "NY",
            "postal_code": "129012413",
            "country_code": "US",
            "telephone_number": "802-864-0192",
            "fax_number": "802-860-4919",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FOUR SEASONS DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A",
        "authorized_official_last_name": "PARTILO",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "802-864-0192",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colchester, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.