NPIMap

Organization Active NPI

Five-Town Health Alliance, Inc

Doing business as Mountain Community Health

  • Dentist
  • Bristol, VT
National Provider Identifier
1013562636
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
FIVE-TOWN HEALTH ALLIANCE, INC
Doing business as
Mountain Community Health
Red Clover Family Dentistry
Practice address
61 Pine St
Bristol, VT 05443-1043
Phone
(802) 453-3911
Fax
(802) 453-2358
NPI assigned
Aug 9, 2019
Last updated
Sep 18, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
FIVE-TOWN HEALTH ALLIANCE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Authorized official

Name
Heidi Melbostad
Title
Chief Executive Officer
Phone
(802) 453-5116

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

61 Pine St
Bristol, VT 05443-1043

Mailing address

61 Pine St
Bristol, VT 05443-1043
Phone (802) 453-3911

Other names 2

  • Mountain Community Health Doing business as
  • Red Clover Family Dentistry Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121204000030 VT Part B Supplier - Clinic/Group Practice 9638321342 Receives reassigned benefits from 17 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Middlebury, VT; Bristol, VT

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Five-Town Health Alliance Inc2 organizations share this tax ID, including this one
Part of
Five-Town Health Alliance Inc

Other organizations with this tax ID 1

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

Locations

61 Pine St
Bldg 4
Bristol, VT 05443
Phone (802) 453-3911

56 College St
Middlebury, VT 05753
Phone (802) 453-5028

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1565308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1013562636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 PINE ST",
            "city": "BRISTOL",
            "state": "VT",
            "postal_code": "054431043",
            "telephone_number": "802-453-3911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 PINE ST",
            "city": "BRISTOL",
            "state": "VT",
            "postal_code": "054431043",
            "telephone_number": "802-453-3911",
            "fax_number": "802-453-2358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE-TOWN HEALTH ALLIANCE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FIVE-TOWN HEALTH ALLIANCE, INC",
        "enumeration_date": "2019-08-09",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A",
        "authorized_official_last_name": "MELBOSTAD",
        "authorized_official_first_name": "HEIDI",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "802-453-5116"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Community Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Red Clover Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bristol, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.