Richard Q Callahan, MSPA, PA-C
Individual provider Active NPI Medical Physician Assistant · Burlington, VT
NPI 1891785671 · NPPES record last updated Nov 12, 2013
Key facts
- NPI
- 1891785671
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 055-0030786 (VT)
- Practice address
- 111 Colchester Ave
Dermatology - Acc/WP-5
Burlington, VT 05401-1473 - Phone
- (802) 847-4570
- Fax
- (802) 847-3364
- NPI assigned
- Oct 24, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 15
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- University of Vermont Medical Center Inc
Practice addresses (Care Compare)
1 S Prospect St
Burlington, VT 05401-3456
Phone (802) 847-0000
111 Colchester Ave
Burlington, VT 05401-1473
Phone (802) 847-0000
Hospital & facility affiliations
- Univ. of Vermont - Fletcher Allen Health Care
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 |
|---|---|---|---|---|
| I20060804000319 | VT | Practitioner - Physician Assistant | 8628094083 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 055-0030786 | VT | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Vermont Medical Center Inc | Current |
Accepting new patients | |
| Robert D Gordon MD Professional Corp | Past | Accepting new patients | |
| Fletcher Allen Health Care Inc | Past | Accepting new patients |
Locations
1 S Prospect St
Burlington, VT 05401
Phone (802) 847-4531
111 Colchester Ave
#5
Burlington, VT 05401
Phone (802) 847-2884
Interoperability endpoints
- rcallahan10751@direct.uvmhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 055-0030786 | VT | |
| Medical Physician Assistant | 363AM0700X | 055-0030786 | VT | Yes |
Addresses
Primary practice location
111 Colchester Ave
Dermatology - Acc/WP-5
Burlington, VT 05401-1473
Mailing address
111 Colchester Ave
Dermatology - Acc/WP-5
Burlington, VT 05401-1473
Phone (802) 847-4570
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 055-0030786 | Other | VT | LICENSE |
Other providers in Burlington, VT
- Alicia B Calacci
- Lindsay Anne Caldarone
- Kelsey Calhoun
- Erin Rae Callahan
- Phillip Callahan
- Clayton Cameron
- Lorelei Barton Camp
- Joseph Campanella
- Allison Elaine Campbell
- Anna Campbell
All providers in Burlington, VT · Medical 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 Nov 12, 2013. 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.