NPIMap

Organization Active NPI

Northwest Community Health Care

  • Federally Qualified Health Center (FQHC)
  • Scituate, RI
National Provider Identifier
1003362864
Registry record updated Aug 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHWEST COMMUNITY HEALTH CARE
Practice address
35 Village Plaza Way
1-53 Village Plaza Way, Units 12 & 13
Scituate, RI 02857-1849
Phone
(401) 567-0800
Fax
(401) 567-0900
NPI assigned
Aug 31, 2016
Last updated
Aug 31, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHWEST COMMUNITY HEALTH CAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 31, 2016

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

Authorized official

Name
Peter Bancroft
Title
President/Ceo
Phone
(401) 285-5119

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

35 Village Plaza Way
1-53 Village Plaza Way, Units 12 & 13
Scituate, RI 02857-1849

Mailing address

35 Village Plaza Way
1-53 Village Plaza Way, Units 12 & 13
Scituate, RI 02857-1849
Phone (401) 567-0800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050308000422 RI Part B Supplier - Clinic/Group Practice 1355250663 Receives reassigned benefits from 49 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pascoag, RI; North Scituate, RI; North Kingstown, RI; Foster, RI
O20161003002627 RI Part A Provider - Federally Qualified Health Center (FQHC) 1355250663 Practice locations: North Scituate, RI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003362864. Details of each certification follow.

Federally qualified health center certification: CCN 411855

Legal name
NORTHWEST COMMUNITY HEALTH CARE
Doing business as
WELLONE PRIMARY MEDICAL AND DENTAL CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 31, 2016
Last certification
Oct 31, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 23, 1929 in RI
Enrollment address
35 Village Plaza Way
1-53-Village Plaza Way Units 12 & 13
North Scituate, RI 2857

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
41D2119710Northwest Community Health Care35 Village Plaza Way, North Scituate, RI 02857Provider-performed microscopyOct 3, 2026

National Provider Directory

National Provider Directory
Part of
Northwest Community Health Care

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
David H. Ferrara Individual Corporate OfficerAssistant Secretary Nov 1, 2004
Corporate DirectorBoard Member Nov 1, 2010
Peter John Bancroft Individual Corporate OfficerPresident & Ceo Oct 12, 1992
W-2 Managing EmployeePresident & Ceo Oct 12, 1992
Christine L Vallee Individual Corporate Director Nov 1, 2008
Margaret Dudley Individual Corporate Director Oct 1, 2020
Diane Hopper Individual Corporate OfficerChief Financial Officer & Vice P Oct 31, 2005
W-2 Managing EmployeeChief Financial Officer & Vice P Oct 31, 2005
Andrea Marcotte Individual Corporate OfficerVice President & Chief Medical O Jan 2, 1997
W-2 Managing EmployeeVice President & Chief Medical O Jan 2, 1997
Darya Kravitz Individual Corporate Director Oct 1, 2020
Crystal L Leddy Individual Corporate OfficerSecretary Oct 1, 2021
Corporate DirectorBoard Member Nov 1, 2011
Dennis Anderson Individual Corporate Director Oct 1, 2020
Deirdre Norton Individual Corporate OfficerVice President Jan 30, 1995
W-2 Managing EmployeeVice President Jan 30, 1995
David Dejesus Individual Corporate OfficerTreasurer Nov 1, 2014
Corporate DirectorBoard Member Nov 1, 2014
Sarah Nottage Individual Corporate OfficerVice Chair Nov 1, 2014
Corporate DirectorBoard Member Nov 1, 2011
Gerald Goulet Individual Corporate OfficerChairman of the Board Oct 1, 2021
Corporate DirectorBoard Member Oct 31, 2016
Joan Hilton Individual Corporate OfficerBoard Chair Nov 1, 2014
Corporate DirectorBoard Member & Board Chair Nov 1, 2014
Joseph Casey Individual Corporate Director May 1, 2022

Practitioners & affiliated clinicians

Practitioners 47

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 47

NPI Registry JSON

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

{
    "created_epoch": "1472601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472601600000",
    "number": "1003362864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 VILLAGE PLAZA WAY",
            "address_2": "1-53 VILLAGE PLAZA WAY, UNITS 12 & 13",
            "city": "SCITUATE",
            "state": "RI",
            "postal_code": "028571849",
            "telephone_number": "401-567-0800",
            "fax_number": "401-567-0900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 VILLAGE PLAZA WAY",
            "address_2": "1-53 VILLAGE PLAZA WAY, UNITS 12 & 13",
            "city": "SCITUATE",
            "state": "RI",
            "postal_code": "028571849",
            "telephone_number": "401-567-0800",
            "fax_number": "401-567-0900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST COMMUNITY HEALTH CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHWEST COMMUNITY HEALTH CARE",
        "enumeration_date": "2016-08-31",
        "last_updated": "2016-08-31",
        "status": "A",
        "authorized_official_last_name": "BANCROFT",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "401-285-5119"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scituate, RI

Sources for this page

Verify at the official NPI Registry.