NPIMap

Individual provider Active NPI

Mirjam McCormack, MD

  • Anesthesiology Physician
  • Morrisville, VT
National Provider Identifier
1891716163
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
0420010794 Issued in VT
Practice address
528 Washington Hwy
Morrisville, VT 05661-8973
Phone
(802) 888-8888
NPI assigned
Jul 22, 2006
Sex
Female
Sole proprietor
No

Organizations & group practices 13

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 13

Hospital & facility affiliations 2

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

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Utah School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rutland Hospital, Inc. 186 clinicians
Anesthesia Associates of Vermont PLC 10 clinicians
Champlain Valley Physicians Hospital Medical Center 356 clinicians

Practice addresses (Care Compare)

160 Allen St
Rutland, VT 05701-4560
Phone (802) 775-7111

593 Hercules Dr
Colchester, VT 05446-5993
Phone (802) 373-5266

75 Beekman St
Plattsburgh, NY 12901-1438
Phone (518) 562-7100

Hospital & facility affiliations

  • Rutland Regional Medical Center Hospital, Rutland, VT, CCN 470005
  • The University of Vermont Health Network - Champl Hospital, Plattsburgh, NY, CCN 330250

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050127000882 VT Practitioner - Anesthesiology 2769432616 Reassigns benefits to 2 organizations
I20140109000015 NY Practitioner - Anesthesiology 2769432616 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0420010794VTMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Associates of Vermont PLC Anesthesiology CurrentSince Oct 1, 2022 Accepting new patients
Rutland Hospital, Inc. CurrentSince Jul 8, 2025 Accepting new patients
Champlain Valley Physicians Hospital Medical Center Anesthesiology CurrentSince Oct 1, 2013 Accepting new patients
Rutland Hospital, Inc. CurrentSince Jul 8, 2025 Accepting new patients

Locations

75 Beekman St
Plattsburgh, NY 12901
Phone (518) 562-7100

593 Hercules Dr
Colchester, VT 05446
Phone (802) 373-5266

160 Allen St
Rutland, VT 05701

Interoperability endpoints

  • Direct secure messaging: mmccormack182649@direct.uvmhealth.org

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
Anesthesiology Physician 207L00000X 0420010794 VT Primary

Addresses

Primary practice location

528 Washington Hwy
Morrisville, VT 05661-8973

Mailing address

528 Washington Hwy
Morrisville, VT 05661-8973

Other identifiers 2

IdentifierTypeStateIssuer
1011031MedicaidVT
00068350OtherVTBLUE CROSS

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891716163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "528 WASHINGTON HWY",
            "city": "MORRISVILLE",
            "state": "VT",
            "postal_code": "056618973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "528 WASHINGTON HWY",
            "city": "MORRISVILLE",
            "state": "VT",
            "postal_code": "056618973",
            "telephone_number": "802-888-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMACK",
        "first_name": "MIRJAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "VT",
            "license": "0420010794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1011031",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "00068350",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Morrisville, VT

Sources for this page

Verify at the official NPI Registry.