NPIMap

Organization Active NPI

Northeastern Vermont Regional Hospital, Inc

Doing business as NVRH Surgical Group

  • Surgery Physician
  • St Johnsbury, VT
National Provider Identifier
1992747737
Registry record updated Apr 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
NORTHEASTERN VERMONT REGIONAL HOSPITAL, INC
Doing business as
NVRH Surgical Group
Practice address
1315 Hospital Dr
St Johnsbury, VT 05819-9210
Phone
(802) 748-8141
Fax
(802) 748-4098
NPI assigned
Jun 12, 2006
Last updated
Apr 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2025

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

Authorized official

Name
Andre Bissonnette
Title
Cfo
Phone
(802) 748-7520

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X
Surgery Physician 208600000X Primary
Audiologist 231H00000X
Critical Access Hospital 282NC0060X 673 VT

Addresses

Primary practice location

1315 Hospital Dr
St Johnsbury, VT 05819-9210

Mailing address

PO Box 905
St Johnsbury, VT 05819-0905
Phone (802) 748-8141

Other practice location 1

1080 Hospital Dr Ste 5
St Johnsbury, VT 05819-6001
Phone (802) 748-5126

Other practice location 2

1290 Hospital Dr Ste 1
St Johnsbury, VT 05819-9205
Phone (802) 748-2984

Other identifiers 2

IdentifierTypeStateIssuer
3076797MedicaidNH
1011326MedicaidVT

Other names 1

  • NVRH Surgical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050411000154 VT Part B Supplier - Clinic/Group Practice 3678481405 Receives reassigned benefits from 30 practitioners
Practice locations: St Johnsbury, VT

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 14

National Provider Directory

National Provider Directory

Locations

79 Swiftwater Rd
Ste 1
Woodsville, NH 03785
Phone (603) 747-2743

1290 Hospital Dr
Ste 1
St Johnsbury, VT 05819
Phone (802) 748-2984

714 Breezy Hill Rd
St Johnsbury, VT 05819
Phone (802) 748-5126

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743984000000",
    "number": "1992747737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 905",
            "city": "ST JOHNSBURY",
            "state": "VT",
            "postal_code": "058190905",
            "telephone_number": "802-748-8141",
            "fax_number": "802-748-4098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 HOSPITAL DR",
            "city": "ST JOHNSBURY",
            "state": "VT",
            "postal_code": "058199210",
            "telephone_number": "802-748-8141",
            "fax_number": "802-748-4098"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1080 Hospital Dr Ste 5",
            "address_purpose": "LOCATION",
            "city": "St Johnsbury",
            "state": "VT",
            "postal_code": "058196001",
            "country_code": "US",
            "telephone_number": "802-748-5126",
            "fax_number": "802-748-1107",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1290 Hospital Dr Ste 1",
            "address_purpose": "LOCATION",
            "city": "St Johnsbury",
            "state": "VT",
            "postal_code": "058199205",
            "country_code": "US",
            "telephone_number": "802-748-2984",
            "fax_number": "802-748-1778",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHEASTERN VERMONT REGIONAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2025-04-07",
        "certification_date": "2025-04-07",
        "status": "A",
        "authorized_official_last_name": "BISSONNETTE",
        "authorized_official_first_name": "ANDRE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "802-748-7520"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "VT",
            "license": "673",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3076797",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1011326",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NVRH Surgical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NVRH Surgical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Johnsbury, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.