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VERNON INTEGRATIVE MEDICAL GROUP LLC NPI 1114175627


NPI Information

NPI: 1114175627
Provider Name: VERNON INTEGRATIVE MEDICAL GROUP LLC
Classification: Internal Medicine - 207R00000X
Entity Type: Organization

CLIA Number: 22D2072006

Address:
10 WINTHROP ST
WORCESTER, MA
ZIP 01604
Phone: (508) 754-9950
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VERNON INTEGRATIVE MEDICAL GROUP LLC is an internal medicine in Worcester, MA. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. VERNON INTEGRATIVE MEDICAL GROUP LLC NPI is 1114175627. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

10 WINTHROP ST
WORCESTER, MA
ZIP 01604
Phone: (508) 754-9950
Fax: (508) 754-2592

The provider's authorized official is Jon Trister .
The authorized official title is Md Internal Medicine and has the following contact phone number (508) 754-9950.

The CLIA number assigned to this NPI record is 22D2072006 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/9/2008 and was last updated on 9/20/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207R00000XInternal Medicine80587MASSACHUSETTSYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
143899OTHERMASSACHUSETTSBMCHP
2G12349MEDICARE UPINMASSACHUSETTS
3110082379AMEDICAIDMASSACHUSETTS
429736OTHERFALLON
5J16290OTHERBLUE CROSS BLUE SHIELD
6080587OTHERTUFTS
76141990001OTHERMASSACHUSETTSNATIONAL SUPPLIER CLEARINGHOUSE
8985162OTHERNETWORK HEALTH
90008944MEDICARE PINMASSACHUSETTS
106141990001MEDICARE NSCMASSACHUSETTS
110400664OTHEREVERCARE
121928586OTHERCIGNA
135841132OTHERMASSACHUSETTSAETNA
1466212OTHERHARVARD PILGRIM
150400053OTHERUNITED HEALTH CARE
1633586OTHERHEALTH NEW ENGLAND
173144941MEDICAIDMASSACHUSETTS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.