Stephen S Kornbluth, M.D.
Individual provider Active NPI Family Medicine Physician · Bomoseen, VT
NPI 1811948847 · NPPES record last updated Sep 2, 2016
Key facts
- NPI
- 1811948847
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 0420011399 (VT)
- Practice address
- 275 Route 30 N
Bomoseen, VT 05732-9647 - Phone
- (802) 468-5641
- Fax
- (802) 468-2923
- NPI assigned
- May 15, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Albany Medical College of Union University, 1980
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Community Health Centers of the Rutland Region Inc
Practice addresses (Care Compare)
275 Route 30 N
Bomoseen, VT 05732-9647
Phone (802) 468-5641
Hospital & facility affiliations
- Vna & Hospice of the Southwest Region, Inc.
- Bayada Home Health Care, Inc.
- Rutland Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070828001010 | VT | Practitioner - Family Practice | 4880786334 | Reassigns benefits to 5 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 153606 | NY | MD | Family Medicine Physician |
| 0420011399 | VT | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Health Centers of the Rutland Region, Inc. | Family Medicine | Current |
Accepting new patients |
| Community Health Centers of the Rutland Region, Inc. | Family Medicine | Current |
Accepting new patients |
| Community Health Centers of the Rutland Region, Inc. | Current |
Accepting new patients | |
| Community Health Centers of the Rutland Region Inc | Family Medicine | Current |
Accepting new patients |
| Community Health Centers of the Rutland Region, Inc | Family Medicine | Current |
Accepting new patients |
| Community Health Centers of the Rutland Region Inc | Family Medicine | Current | Accepting new patients |
| Community Health Centers of the Rutland Region, Inc. | Family Medicine | Current |
Accepting new patients |
| Ozarks Medical Center | Family Medicine | Past | Accepting new patients |
Locations
275 VT 30 N
Bomoseen, VT 05732
Phone (802) 468-5641
420 Grove St
Brandon, VT 05733
Phone (802) 247-6305
71 Allen St
Ste 402
Rutland, VT 05701
Phone (800) 468-9118
71 Allen St
Ste 403
Rutland, VT 05701
Phone (802) 772-4414
1 General Wing Rd
Rutland, VT 05701
Phone (802) 773-9131
2987 Vt Route 22A
Shoreham, VT 05770
Phone (802) 897-7000
278 Vt Route 149
West Pawlet, VT 05775
Phone (800) 468-9118
Interoperability endpoints
- skornbluth@chcrr.medentdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 153606 | NY | |
| Family Medicine Physician | 207Q00000X | 0420011399 | VT | Yes |
Addresses
Primary practice location
275 Route 30 N
Bomoseen, VT 05732-9647
Mailing address
71 Allen Street
Suite 403
Rutland, VT 05701-4570
Phone (802) 772-4414
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00479978 | Other | VT | RR MEDICARE |
| 1013905 | Medicaid | VT | |
| 00773271 | Medicaid | NY |
Other providers in Bomoseen, VT
- Andrea R Hubbard Maclauchlan
- Jayme Hughes
- JMS Pharmacy Management Inc
- Erin Joiner
- Pauline Kahng
- KPH Healthcare Services, Inc.
- Hannah Mary Kussel
- Lakewood Adult Family Home Inc
- Jessica C Lindert
- Colleen Mitchell
All providers in Bomoseen, VT · Family Medicine Physician in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.