NPIMap

Individual provider Active NPI

Jill I Blumberg, M.D.

  • Family Medicine Physician
  • White River Junction, VT
National Provider Identifier
1811961576
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0420012818 Issued in VT
Practice address
331 Olcott Dr
Suite U3
White River Junction, VT 05001-9601
Phone
(802) 295-6132
NPI assigned
Feb 17, 2006
Last updated
Mar 29, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0420012818 VT Primary

Addresses

Primary practice location

331 Olcott Dr
Suite U3
White River Junction, VT 05001-9601

Mailing address

331 Olcott Dr
Suite U3
White River Junction, VT 05001-9601
Phone (802) 295-6132

Other identifiers 2

IdentifierTypeStateIssuer
30203299MedicaidNH
1009068MedicaidVT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140131001277 VT Practitioner - Family Practice 5890719389 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Connecticut School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
White River Family Practice PCGroup PAC ID 3971561358, 9 clinicians

Practice addresses (Care Compare)

331 Olcott Dr
Suite U3
White River Junction, VT 05001-9263
Phone (802) 295-6132

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0420012818VTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
White River Family Practice PC Family Medicine CurrentSince Jan 10, 2014 Accepting new patients

Locations

331 Olcott Dr
Ste 3
White River Junction, VT 05001

331 Olcott Dr
Ste U3
White River Junction, VT 05001
Phone (802) 295-6132

Interoperability endpoints

  • Direct secure messaging: jill.blumberg@wrfp.eclinicaldirectplus.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1811961576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "331 OLCOTT DR",
            "address_2": "SUITE U3",
            "city": "WHITE RIVER JUNCTION",
            "state": "VT",
            "postal_code": "050019601",
            "telephone_number": "802-295-6132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 OLCOTT DR",
            "address_2": "SUITE U3",
            "city": "WHITE RIVER JUNCTION",
            "state": "VT",
            "postal_code": "050019601",
            "telephone_number": "802-295-6132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUMBERG",
        "first_name": "JILL",
        "middle_name": "I",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-17",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VT",
            "license": "0420012818",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30203299",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1009068",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in White River Junction, VT

Sources for this page

Verify at the official NPI Registry.