BETHANY LYNN STACK (P.A.) – Medical Physician Assistant, NPI 1184619876
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
385 PHYSICIAN ASSISTANT in VT
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Provider Addresses for BETHANY LYNN STACK (P.A.)
3, Albert Cree Drive, Billings Mobile Manor, Rutland City, Rutland County, Vermont, 05701, United States
RUTLAND, VT 057014601
Phone: (802) 775-2937
Fax: (802) 773-0934
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.
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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: 2004-07-28
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20040728001404 | I | Physician Assistant | VT | TBD |
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.
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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 20610 | Aspiration and/or injection of fluid from large joint | 167 | 105 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 120 | 104 | $0 |
| 27447 | Replacement of knee joint, both sides of knee | 55 | 55 | $0 |
| 73030 | X-ray of shoulder, minimum of 2 views | 46 | 46 | $0 |
| 73562 | X-ray of knee, 3 views | 43 | 43 | $0 |
Insurance plans in this area (ZIP 05701)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| Orthopedic Surgery | VT | |
| Orthopedic Surgery | VT | |
| - | VT | |
| Pulmonary Disease, Critical Care (Intensivists) | DE | |
| Internal Medicine | VT | |
| O B S T E T R I C S/ G Y N E C O L O G Y | DC | |
| Hospitalist, Internal Medicine | MA | |
| Emergency Medicine | VT | |
| Certified Registered Nurse Anesthetist (Crna) | FL | |
| - | VT |
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