dba Brandon Medical Center – Family Medicine Physician, NPI 1073567590
Family Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for dba Brandon Medical Center
71, Allen Street, Brookside Trailer Park, Rutland City, Rutland County, Vermont, 05701, United States
SUITE 101
RUTLAND, VT 057014570
Phone: (800) 468-9118
Fax: (802) 772-7973
Type: Mailing
420, Grove Street, Mount Pleasant, Brandon, Rutland County, Vermont, 05733, United States
BRANDON, VT 057339062
Phone: (802) 247-6305
Fax: (802) 247-6040
Type: Location
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: 2006-04-04
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-09-30 (989 days ago).
Enrollment records
2
Earliest due date
2023-09-30
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 |
|---|---|---|---|---|
| O20041129000784 | O | Clinic/Group Practice | VT | 2023-09-30 |
| O20060404000315 | O | Federally Qualified Health Center (Fqhc) | VT | 2025-11-30 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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 05701)
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