CAROLYNNE FAGAN – Athletic Trainer, NPI 1043809064

CAROLYNNE FAGAN is a healthcare provider. based in Milton, Vermont. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. The NPI Number for CAROLYNNE FAGAN is 1043809064

Main info

Female
2 Years Of Experience
Accepts Medicare Assignment
Name
CAROLYNNE FAGAN
NPI
1043809064
Phone
(802) 893-1642
Address
32 STACY ST
Enumeration Date
14 January 2021
Last Update Date
14 January 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8028937427
Graduation Year
2024 (2 years ago)
PAC ID
3971044694
Group Practice PAC ID
0244200095
Professional Enrollment ID
I20240923000363
Address ID
VT054683602MI184XXSXXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience30
Completeness75
Years active:5State licenses:0Digital endpointsOther names

300 PHYSICAL THERAPIST IN PRIVATE PRACTICE in VT

Provider Addresses for CAROLYNNE FAGAN

  • 32 STACY ST

    MILTON, VT 054684161

    Phone: (802) 893-1642

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-09-23

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240923000363IPhysical Therapist In Private PracticeVTTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 05468)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0244200095View full group profile
NameSpecialtyState
-VT
-NH
Physical Therapist In Private PracticeVT
-VT
Physical Therapist In Private PracticeVT
Physical Therapist In Private PracticeVT
Physical Therapist In Private PracticeVT

Reviews

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Frequently asked questions

Is CAROLYNNE FAGAN listed with a National Provider Identifier?
Yes — CAROLYNNE FAGAN has NPI 1043809064 on file in the registry.
Is there an active status for CAROLYNNE FAGAN?
For scheduling context, CAROLYNNE FAGAN is shown as active in the registry.
What clinical focus is listed for CAROLYNNE FAGAN?
At a glance, CAROLYNNE FAGAN is tied to Athletic Trainer. Clinical services aligned with this taxonomy classification.
What practice footprint exists for CAROLYNNE FAGAN?
Travel planning: use Milton, Vermont as the reference point for CAROLYNNE FAGAN, then confirm.
When was this NPI issued?
Enumeration for CAROLYNNE FAGAN is noted as January 14, 2021 where the registry provides it.

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