Active NPI
Vivian M Calobrisi, PA-C
- Physician Assistant
- Newport, VT
National Provider Identifier
1801973334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0550030279
- Practice address
- 41 Medical Village Dr
Newport, VT 05855-9835 - Phone
- (802) 334-3504
- Fax
- (802) 334-3512
- NPI assigned
- Nov 1, 2006
- Last updated
- Jun 16, 2009
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0550030279 | VT | Primary |
Addresses
Primary practice location
41 Medical Village Dr
Newport, VT 05855-9835
Mailing address
41 Medical Village Dr
Newport, VT 05855-9835
Phone (802) 334-3504
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00055182 | Other | VT | RAILROAD MEDICARE |
| 00028004 | Other | VT | BLUE SHIELD |
| 118505 | Other | VT | MVP |
| 0002510 | Medicaid | VT | |
| 8000219 | Other | VT | LADIES FIRST |
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0550030279 | VT | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245110400000",
"number": "1801973334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41 MEDICAL VILLAGE DR",
"city": "NEWPORT",
"state": "VT",
"postal_code": "058559835",
"telephone_number": "802-334-3504",
"fax_number": "802-334-3512"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41 MEDICAL VILLAGE DR",
"city": "NEWPORT",
"state": "VT",
"postal_code": "058559835",
"telephone_number": "802-334-3504",
"fax_number": "802-334-3512"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CALOBRISI",
"first_name": "VIVIAN",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-01",
"last_updated": "2009-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VT",
"license": "0550030279",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00055182",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "00028004",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP",
"identifier": "118505",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0002510",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LADIES FIRST",
"identifier": "8000219",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newport, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.