Active NPI
Mark M Nunlist, M.D.
- Family Medicine Physician
- White River Junction, VT
National Provider Identifier
1801891882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 042-0006923
- Practice address
- 331 Olcott Dr
Ste U3
White River Junction, VT 05001-9601 - Phone
- (802) 295-6132
- Fax
- (802) 295-1358
- NPI assigned
- Jun 16, 2005
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 042-0006923 | VT | Primary |
Addresses
Primary practice location
331 Olcott Dr
Ste U3
White River Junction, VT 05001-9601
Mailing address
331 Olcott Dr
Ste U3
White River Junction, VT 05001-9601
Phone (802) 295-6132
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8000076 | Medicaid | VT | |
| 5593 | Medicaid | VT | |
| Y400215412 | Other | VT | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042-0006923 | VT | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dartmouth-Hitchcock Clinic | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Lebanon, NH
- NPI 1548210198
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433980800000",
"number": "1801891882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "331 OLCOTT DR",
"address_2": "STE U3",
"city": "WHITE RIVER JUNCTION",
"state": "VT",
"postal_code": "050019601",
"telephone_number": "802-295-6132",
"fax_number": "802-295-1358"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "331 OLCOTT DR",
"address_2": "STE U3",
"city": "WHITE RIVER JUNCTION",
"state": "VT",
"postal_code": "050019601",
"telephone_number": "802-295-6132",
"fax_number": "802-295-1358"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NUNLIST",
"first_name": "MARK",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-16",
"last_updated": "2015-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "VT",
"license": "042-0006923",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8000076",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5593",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "Y400215412",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in White River Junction, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.