NPIMap

Organization Active NPI

Northern Counties Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Newport, VT
National Provider Identifier
1003564931
Registry record updated Mar 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHERN COUNTIES HEALTH CARE, INC.
Practice address
137 Main St Ste 102
Newport, VT 05855-4415
Phone
(802) 995-2412
NPI assigned
Mar 10, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2022

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

Authorized official

Name
Stacey Tanner
Title
Human Resources Generalist
Phone
(802) 748-9405

Specialties & licenses 1

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

Addresses

Primary practice location

137 Main St Ste 102
Newport, VT 05855-4415

Mailing address

137 Main St Ste 102
Newport, VT 05855-4415
Phone (802) 995-2412

Other names 1

  • Northern Express Care Newport Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220509002038 VT Part A Provider - Federally Qualified Health Center (FQHC) 2860300936 Practice locations: Newport, VT

Federally qualified health center certification: CCN 471876

Legal name
NORTHERN COUNTIES HEALTH CARE INC
Doing business as
NORTHERN EXPRESS CARE NEWPORT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 25, 2022
Last certification
Apr 25, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 23, 1976 in VT
Enrollment address
137 Main St
Ste 102
Newport, VT 58554415

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Hardwick Area HLTH Cent17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Locations

26 Cedar Ln
Danville, VT 05828
Phone (802) 684-2275

137 Main St
Ste 102
Newport, VT 05855
Phone (802) 995-2412

185 Sherman Dr
#2
St Johnsbury, VT 05819
Phone (802) 748-5174

457 Railroad St
#2
St Johnsbury, VT 05819
Phone (802) 633-6351

185 Sherman Dr
St Johnsbury, VT 05819
Phone (802) 748-5041

185 Sherman Dr
#1
St Johnsbury, VT 05819
Phone (802) 748-5041

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Pamela Smart Individual Corporate Director Oct 28, 2020
Angela Neil Individual Corporate OfficerChief Financial Officer May 1, 2021
Patricia Aubin Individual Corporate Director Oct 27, 2021
Michael K Costa Individual Corporate OfficerChief Executive Officer Mar 19, 2019
W-2 Managing Employee Mar 19, 2019
Karena Shippee Individual Corporate Director Jun 22, 2016
Adrianne Hutchin Individual Corporate Director Oct 27, 2021
Justin Barton-Caplin Individual Corporate Director Oct 28, 2020
Alan Cronauer Individual Corporate Director Aug 23, 2017
Laura Newell Individual Corporate Director Apr 24, 2019
Steven Winkler Individual Corporate Director Oct 27, 2021
Sarah Rebecca Galloway Individual Corporate Director Oct 28, 2020
Maryellen Griffin Individual Corporate Director Oct 28, 2020
Ellen CF Moore Individual Corporate Director Oct 24, 2018
Ann Creaven Individual Corporate Director Sep 26, 2018
Louisa Driscoll Individual Corporate Director Oct 28, 2020
Sophia Boyle Hall Individual Corporate Director Oct 28, 2020

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 84

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 84

NPI Registry JSON

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

{
    "created_epoch": "1646870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646870400000",
    "number": "1003564931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "137 MAIN ST STE 102",
            "city": "NEWPORT",
            "state": "VT",
            "postal_code": "058554415",
            "telephone_number": "802-995-2412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "137 MAIN ST STE 102",
            "city": "NEWPORT",
            "state": "VT",
            "postal_code": "058554415",
            "telephone_number": "802-995-2412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN COUNTIES HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-10",
        "last_updated": "2022-03-10",
        "certification_date": "2022-03-10",
        "status": "A",
        "authorized_official_last_name": "TANNER",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "HUMAN RESOURCES GENERALIST",
        "authorized_official_telephone_number": "802-748-9405"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Express Care Newport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newport, VT

Sources for this page

Verify at the official NPI Registry.