Individual provider Active NPI

Jessica S Racusin, MD

  • Emergency Medicine Physician
  • Middlebury, VT
National Provider Identifier
1821192089
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
0420010785 Issued in VT
Practice address
115 Porter Dr
Porter Hospital
Middlebury, VT 05753
Phone
(802) 388-4001
Fax
(802) 388-5612
NPI assigned
Sep 11, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 0420010785 VT Primary

Addresses

Primary practice location

115 Porter Dr
Porter Hospital
Middlebury, VT 05753

Mailing address

115 Porter Dr
40 Susan Spitzner Finance Dept
Middlebury, VT 05753
Phone (802) 388-5607

Other identifiers 3

IdentifierTypeStateIssuer
68063OtherVTBCBS
4127323OtherVTMVP VT MGD CARE
1010640MedicaidVT

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040714000281 VT Practitioner - Emergency Medicine 5294714309 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0420010785VTMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Porter Hospital Inc Current Accepting new patients

Locations

115 Porter Dr
Middlebury, VT 05753
Phone (802) 388-4701

115 Porter Dr
#40
Middlebury, VT 05753

Interoperability endpoints

  • Direct secure messaging: jracusin15872@direct.uvmhealth.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821192089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 PORTER DR",
            "address_2": "40 SUSAN SPITZNER FINANCE DEPT",
            "city": "MIDDLEBURY",
            "state": "VT",
            "postal_code": "05753",
            "telephone_number": "802-388-5607",
            "fax_number": "802-388-5654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 PORTER DR",
            "address_2": "PORTER HOSPITAL",
            "city": "MIDDLEBURY",
            "state": "VT",
            "postal_code": "05753",
            "telephone_number": "802-388-4001",
            "fax_number": "802-388-5612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RACUSIN",
        "first_name": "JESSICA",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VT",
            "license": "0420010785",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "68063",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP VT MGD CARE",
            "identifier": "4127323",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1010640",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Middlebury, VT

Sources for this page

Verify at the official NPI Registry.