Active NPI
Patrick Cornelius Kearney, PA
- Physician Assistant
- Williston, VT
National Provider Identifier
1801868005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 055-0030829
- Practice address
- 28 Park Ave
Williston, VT 05495-9701 - Phone
- (802) 878-1008
- Fax
- (802) 872-2679
- NPI assigned
- Feb 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 055-0030829 | VT | Primary |
| Physician Assistant | 363A00000X | 055-0030968 | VT |
Addresses
Primary practice location
28 Park Ave
Williston, VT 05495-9701
Mailing address
28 Park Ave
Primary Care
Williston, VT 05495-9701
Phone (802) 878-1008
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9000255 | Medicaid | VT | |
| AP260801 | Other | MEDICARE PTAN |
Other names 1
- Padraig Cornelius Kearney
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060323000704 | VT | Practitioner - Physician Assistant | 1355359902 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 055-0030829 | VT | MD | Physician Assistant |
| 055-0030968 | VT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwestern Medical Center, Inc. | Past | Accepting new patients | |
| Alder Brook Family Health P.C. | Past | Accepting new patients |
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.
-
- Family Medicine Physician
- Essex Junction, VT
- NPI 1952332124
-
- General Acute Care Hospital
- Saint Albans, VT
- NPI 1720112659
Hospital & facility affiliations 18
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Family Medicine Physician
- Middlebury, VT
- NPI 1558381889
Hospital
-
- Family Medicine Physician
- Middlebury, VT
- NPI 1144240474
Hospital
-
- Hospice and Palliative Medicine (Family Medicine) Physician
- Middlebury, VT
- NPI 1033340641
Hospital
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Evergreen Family Health Partners
Practice addresses (Care Compare)
426 Industrial Ave
Suite 130
Williston, VT 05495-4449
Phone (802) 878-1008
8 Essex Way
201 Dba Alderbrook Family Health
Essex Junction, VT 05452-3422
Phone (802) 872-7100
Hospital & facility affiliations
- Univ. of Vermont - Fletcher Allen Health Care
- Porter Hospital Inc
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416873600000",
"number": "1801868005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28 PARK AVE",
"address_2": "PRIMARY CARE",
"city": "WILLISTON",
"state": "VT",
"postal_code": "054959701",
"telephone_number": "802-878-1008",
"fax_number": "802-872-2679"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28 PARK AVE",
"city": "WILLISTON",
"state": "VT",
"postal_code": "054959701",
"telephone_number": "802-878-1008",
"fax_number": "802-872-2679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEARNEY",
"first_name": "PATRICK",
"middle_name": "CORNELIUS",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-02",
"last_updated": "2014-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VT",
"license": "055-0030829",
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VT",
"license": "055-0030968",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9000255",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "AP260801",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"first_name": "PADRAIG",
"last_name": "KEARNEY",
"middle_name": "CORNELIUS",
"credential": "PA-C",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Williston, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.