NPIMap

Organization Active NPI

Greater Seacoast Community Health

  • Federally Qualified Health Center (FQHC)
  • Greenland, NH
National Provider Identifier
1013688100
Registry record updated Sep 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GREATER SEACOAST COMMUNITY HEALTH
Practice address
575 Portsmouth Ave
Greenland, NH 03840-2251
Phone
(603) 422-8208
Fax
(603) 422-8218
NPI assigned
Sep 28, 2021
Last updated
Sep 28, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2021

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

Authorized official

Name
Elizabeth Ann Carmer
Title
Administrative Assistant
Phone
(603) 749-2346

Specialties & licenses 1

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

Addresses

Primary practice location

575 Portsmouth Ave
Greenland, NH 03840-2251

Mailing address

311 Route 108
Somersworth, NH 03878-1522
Phone (603) 749-2346

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211011001996 NH Part A Provider - Federally Qualified Health Center (FQHC) 2769454974 Practice locations: Greenland, NH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013688100. Details of each certification follow.

Federally qualified health center certification: CCN 301855

Legal name
GREATER SEACOAST COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 29, 2021
Last certification
Oct 29, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 23, 2017 in NH
Enrollment address
575 Portsmouth Ave
Greenland Town Hall
Greenland, NH 3840

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Avis Goodwin Community Health Center14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

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
Yulia Rothenberg Individual Corporate DirectorBoard Member Oct 1, 2021
Jo Jordan Individual Corporate DirectorBoard Member Oct 1, 2021
Allison Neal Individual Corporate DirectorBoard Member Oct 1, 2021
Jennifer Glidden Individual Corporate DirectorBoard Secretary Oct 1, 2021
Karin Barndollar Individual Corporate DirectorBoard Member Oct 1, 2021
Jeffrey M Segil Individual Corporate DirectorBoard Member Oct 1, 2021
Janet M Laatsch Individual Corporate DirectorCeo Oct 1, 2021
Mark Boulanger Individual Corporate DirectorBoard Member Oct 1, 2021
Valerie Goodwin Individual Corporate DirectorBoard Vice Chair Oct 1, 2021
Kimberly a Garca Individual W-2 Managing EmployeePatient Account Director Oct 1, 2021
Kathy Scheu Individual Corporate DirectorBoard Member Oct 1, 2021
Dennis Veilleux Individual Corporate DirectorBoard Treasurer Oct 1, 2021
Donald Chick Individual Corporate DirectorBoard Member Oct 1, 2021
Barbara Henry Individual Corporate DirectorBoard Chair Oct 1, 2021
David Staples Individual Corporate DirectorBoard Member Oct 1, 2021

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1632787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632787200000",
    "number": "1013688100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 ROUTE 108",
            "city": "SOMERSWORTH",
            "state": "NH",
            "postal_code": "038781522",
            "telephone_number": "603-749-2346",
            "fax_number": "603-953-0066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 PORTSMOUTH AVE",
            "city": "GREENLAND",
            "state": "NH",
            "postal_code": "038402251",
            "telephone_number": "603-422-8208",
            "fax_number": "603-422-8218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER SEACOAST COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-28",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A",
        "authorized_official_last_name": "CARMER",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "603-749-2346"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenland, NH

Sources for this page

Verify at the official NPI Registry.