Carlton L. Kellogg, PA-C
Individual provider Active NPI Physician Assistant · Rutland, VT
NPI 1861162299 · NPPES record last updated Sep 16, 2021
Key facts
- NPI
- 1861162299
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 055.0031529 (VT)
- Practice address
- 1 Commons St
Rutland, VT 05701-4652 - Phone
- (802) 747-1857
- Fax
- (802) 747-0129
- NPI assigned
- Sep 16, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Rutland Hospital, Inc.
Practice addresses (Care Compare)
1 Commons St
Rutland, VT 05701-4652
Phone (802) 775-7111
51 Tennis Way
East Dorset, VT 05253-4410
Phone (802) 366-8195
Hospital & facility affiliations
- 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: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211025002764 | VT | Practitioner - Physician Assistant | 3870981814 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rutland Hospital, Inc. | Current |
Accepting new patients |
Locations
51 Tennis Way
East Dorset, VT 05253
Phone (802) 366-8195
160 Allen St
Rutland, VT 05701
1 Commons St
Rutland, VT 05701
Phone (802) 747-1857
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 055.0031529 | VT | Yes |
Addresses
Primary practice location
1 Commons St
Rutland, VT 05701-4652
Mailing address
2041 Russellville Rd
Shrewsbury, VT 05738-9444
Phone (802) 779-6744
Other providers in Rutland, VT
- Patrick Keenan
- Keene Medical Products, LLC
- Jason William Keicher
- William Daniel Kelley Jr.
- Laurel H Kelliher
- Gordon R Kelly
- Louise Anne Kenney
- Michael Kenosh
- Ali J Kenyon
- Christina Huth Keshava
All providers in Rutland, VT · Physician Assistant 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 16, 2021. 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.