NPIMap

Individual provider Active NPI

Pedro Vinicius Staziaki, M.D.

  • Diagnostic Radiology Physician
  • Burlington, VT
National Provider Identifier
1912358318
Registry record updated Jul 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
042-0015695 Issued in VT
Practice address
111 Colchester Ave
Burlington, VT 05401-1473
Phone
(802) 847-0000
NPI assigned
Jun 27, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 268556 MA
Internal Medicine Physician 207R00000X 268556 MA
Diagnostic Radiology Physician 2085R0202X 042-0015695 VT Primary

Addresses

Primary practice location

111 Colchester Ave
Burlington, VT 05401-1473

Mailing address

111 Colchester Ave
Burlington, VT 05401-1473
Phone (802) 847-0000

Other practice location 1

820 Harrison Ave Bldg 3
Boston, MA 02118-2905
Phone (617) 414-5135

Other practice location 2

115 Lincoln St
Framingham, MA 01702-6358
Phone (508) 383-1555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT, NY, FL3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20220802001013 VT Practitioner - Diagnostic Radiology 3577836410 Reassigns benefits to 4 organizations
I20240517002118 NY Practitioner - Diagnostic Radiology 3577836410 Reassigns benefits to 8 organizations
I20260202001491 FL Practitioner - Diagnostic Radiology 3577836410 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Porter Hospital IncGroup PAC ID 1850365180, shared by 5 NPIs, 116 clinicians
Alice Hyde Medical CenterGroup PAC ID 4082525837, 88 clinicians
Elizabethtown Community HospitalGroup PAC ID 3577554138, shared by 3 NPIs, 62 clinicians

Practice addresses (Care Compare)

111 Colchester Ave
Burlington, VT 05401-1473
Phone (802) 847-0000

115 Porter Dr
Middlebury, VT 05753-8423
Phone (802) 388-4701

133 Park St
Malone, NY 12953-1243
Phone (518) 481-2545

4 Independence Dr
Plattsburgh, NY 12901-9775
Phone (802) 388-4430

75 Beekman St
Plattsburgh, NY 12901-1438
Phone (518) 561-2000

75 Park St
Elizabethtown, NY 12932-2300
Phone (518) 673-6377

82 Catamount Park
Middlebury, VT 05753-1292
Phone (802) 388-7185

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Elizabethtown Community Hospital Current Accepting new patients
Champlain Valley Physicians Hospital Medical Center Internal Medicine CurrentSince Apr 9, 2024 Accepting new patients
Central Vermont Medical Center Inc Internal Medicine CurrentSince Mar 27, 2024 Accepting new patients
Alice Hyde Medical Center Current Accepting new patients
Alice Hyde Medical Center Internal Medicine CurrentSince Apr 9, 2024 Accepting new patients
Elizabethtown Community Hospital CurrentSince Apr 9, 2024 Accepting new patients
Porter Hospital, Inc Internal Medicine CurrentSince Mar 27, 2024 Accepting new patients
University of Vermont Medical Center Inc Internal Medicine CurrentSince Jun 15, 2022 Accepting new patients
Porter Hospital Inc Current Accepting new patients
Alice Hyde Medical Center Past Accepting new patients

Locations

969 State Route 11
Moira, NY 12957
Phone (518) 529-7847

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

130 Fisher Rd
#C
Berlin, VT 05602
Phone (802) 225-5400

111 Colchester Ave
Burlington, VT 05401
Phone (802) 656-2415

1 S Prospect St
Burlington, VT 05401
Phone (802) 847-4531

104 Porter Dr
Middlebury, VT 05753
Phone (802) 388-5682

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

82 Catamount Park
Middlebury, VT 05753
Phone (802) 388-7185

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/elizabe-e663f886
  • Direct secure messaging: pstaziaki505628@direct.uvmhealth.org

Organizations & group practices 10

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.

Hospital & facility affiliations 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1466985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657843200000",
    "number": "1912358318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 COLCHESTER AVE",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054011473",
            "telephone_number": "802-847-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 COLCHESTER AVE",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054011473",
            "telephone_number": "802-847-0000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "820 Harrison Ave Bldg 3",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021182905",
            "country_code": "US",
            "telephone_number": "617-414-5135",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "115 Lincoln St",
            "address_purpose": "LOCATION",
            "city": "Framingham",
            "state": "MA",
            "postal_code": "017026358",
            "country_code": "US",
            "telephone_number": "508-383-1555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STAZIAKI",
        "first_name": "PEDRO",
        "middle_name": "VINICIUS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-27",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MA",
            "license": "268556",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "268556",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VT",
            "license": "042-0015695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, VT

Sources for this page

Verify at the official NPI Registry.