NPIMap

Individual provider Active NPI

Tina Marie D'Amato, D.O.

  • Family Medicine Physician
  • South Burlington, VT
National Provider Identifier
1902957020
Registry record updated Nov 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
032-0000547 Issued in VT
Practice address
75 San Remo Dr
204
South Burlington, VT 05403-6385
Phone
(802) 658-9440
Fax
(802) 658-9443
NPI assigned
Jan 16, 2007
Last updated
Nov 15, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2016

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 032-0000547 VT Primary

Addresses

Primary practice location

75 San Remo Dr
204
South Burlington, VT 05403-6385

Mailing address

75 San Remo Dr
204
South Burlington, VT 05403-6385
Phone (802) 658-9440

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
I20070831000260 VT Practitioner - Family Practice 9931292216 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of New England, College of Osteo Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Evergreen Family Health PartnersGroup PAC ID 1153402888, 20 clinicians

Practice addresses (Care Compare)

426 Industrial Ave
Suite 130
Williston, VT 05495-4449
Phone (802) 878-1008

8 Essex Way
201 Dba Alderbrook Family Health
Essex Junction, VT 05452-3422
Phone (802) 872-7100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
032-0000547VTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Evergreen Family Health Partners Family Medicine CurrentSince Oct 1, 2018 Accepting new patients
Alder Brook Family Health P.C. Family Medicine PastSince Feb 8, 2015 Accepting new patients

Locations

8 Essex Way
Ste 201
Essex Junction, VT 05452
Phone (802) 872-7100

28 Park Ave
Williston, VT 05495
Phone (802) 878-1008

426 Industrial Ave
Ste 130
Williston, VT 05495
Phone (518) 593-7466

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.

Hospital & facility affiliations 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479168000000",
    "number": "1902957020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 SAN REMO DR",
            "address_2": "204",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054036385",
            "telephone_number": "802-658-9440",
            "fax_number": "802-658-9443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 SAN REMO DR",
            "address_2": "204",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054036385",
            "telephone_number": "802-658-9440",
            "fax_number": "802-658-9443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "D'AMATO",
        "first_name": "TINA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-16",
        "last_updated": "2016-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VT",
            "license": "032-0000547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Burlington, VT

Sources for this page

Verify at the official NPI Registry.