NPIMap

Organization Active NPI

Mary Hitchcock Memorial Hospital

  • General Acute Care Hospital
  • Lebanon, NH
National Provider Identifier
1023092053
Registry record updated Aug 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
01799 Issued in NH
Legal business name
MARY HITCHCOCK MEMORIAL HOSPITAL
Practice address
One Medical Center Dr
Lebanon, NH 03756-0001
Phone
(603) 650-5000
NPI assigned
Dec 2, 2005
Last updated
Aug 31, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2026

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

Authorized official

Name
Mr. Daniel P. Jantzen
Title
Chief Financial Officer
Phone
(603) 650-5668

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 01799 NH
Emergency Care Clinic/Center 261QE0002X 01799 NH
Hearing and Speech Clinic/Center 261QH0700X 01799 NH
Psychiatric Hospital Unit 273R00000X 01799 NH
General Acute Care Hospital 282N00000X 01799 NH Primary
Durable Medical Equipment & Medical Supplies 332B00000X 01799 NH
Air Ambulance 3416A0800X 0920 VT
Air Ambulance 3416A0800X 0296 NH
Land Ambulance 3416L0300X NU

Addresses

Primary practice location

One Medical Center Dr
Lebanon, NH 03756-0001

Mailing address

PO Box 419112
Boston, MA 02241-9112
Phone (603) 650-5000

Other identifiers 11

IdentifierTypeStateIssuer
3076533MedicaidNH
30210001MedicaidNH
30011095MedicaidNH
80300003MedicaidNH
DE1531OtherVTRAILROAD MEDICARE
CD9167OtherNHRAILROAD MEDICARE
30005466MedicaidNH
0300003MedicaidVT
0300900MedicaidVT
0RE2206MedicaidVT
80300900MedicaidNH

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH, VT, FL, CT, ME, MA, WA8 enrollments

Enrollment records 8

Enrollment IDStateProvider typePAC IDDetails
O20031126000258 NH Part B Supplier - Clinic/Group Practice 4486561164 Receives reassigned benefits from 2,829 practitioners
2 other NPIs on this enrollment
Practice locations: Lebanon, NH; Lyme, NH; Manchester, NH; Merrimack, NH; Milford, NH; Nashua, NH; Walpole, NH; Winchester, NH…
O20040113000148 NH Part A Provider - Hospital 4486561164 2 other NPIs on this enrollment
O20050106000681 VT Part B Supplier - Clinic/Group Practice 4486561164 Receives reassigned benefits from 85 practitioners
1 other NPI on this enrollment
Practice locations: Springfield, VT; Stowe, VT; St Johnsbury, VT; Norwich, VT; Dorset, VT; Burlington, VT
O20240329000063 FL Part B Supplier - Clinic/Group Practice 4486561164 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Jupiter, FL; Hallandale Beach, FL
O20240503001605 CT Part B Supplier - Clinic/Group Practice 4486561164 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Madison, CT
O20240611001289 ME Part B Supplier - Clinic/Group Practice 4486561164 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
Practice locations: Mount Desert, ME
O20240715000579 MA Part B Supplier - Clinic/Group Practice 4486561164 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
Practice locations: Quincy, MA
O20260610001991 WA Part B Supplier - Clinic/Group Practice 4486561164 Receives reassigned benefits from 1 practitioner
Practice locations: Vancouver, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023092053. Details of each certification follow.

Hospital certification: CCN 300003

Legal name
MARY HITCHCOCK MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Dec 14, 2017
Beds
396
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
1 Medical Center Dr
Lebanon, NH 37561000
Main/Primary Hospital Location
Hospital subgroups
General, Acute care, Psychiatric, Short-term, Other

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Mary Hitchcock Memorial HospitalCCN 300003 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member organizations 5

Organizations listed as members of this organization in the National Provider Directory.

Locations

204 Dartmouth College Hwy
Lyme, NH 03768
Phone (603) 650-1070

Ownership & related parties

All disclosed owners & managing parties 25

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

NameRoleSinceShare
Duane M Compton Individual Corporate DirectorBoard Member Jul 1, 2014
Roberta L Hines Individual Corporate DirectorBoard Member Apr 1, 2019
Kimberly Mender Individual Corporate DirectorDirector, Revenue Management System Nov 26, 2003
W-2 Managing EmployeeDirector, Revenue Management System Nov 26, 2003
Jason T Garbarino Individual Corporate Director Jan 18, 2025
Jonathan B Thyng Individual Corporate DirectorMD, Board Member Jan 1, 2024
Laurel J Richie Individual Corporate Director Jan 1, 2025
David Paul Individual Corporate DirectorBoard Member Jan 1, 2020
Daniel P Jantzen Individual Corporate OfficerEx VP Cfo, Authorized Official 1 Aug 1, 2016
Jennifer Moyer Individual Corporate DirectorBoard Member Jan 1, 2020
Joanne Conroy Individual Corporate OfficerBoard Member Ceo President Aug 7, 2017
W-2 Managing Employee Aug 7, 2017
Geraldine D. Bednash Individual Corporate DirectorBoard Member Jan 1, 2021
Celestina Dooley-Jones Individual Corporate DirectorBoard Member Jan 1, 2023
Tegan Deogburn Individual Corporate DirectorDirector - Mso Jan 1, 2025
W-2 Managing EmployeeDirector, Medical Staff Office Jan 1, 2025
Keith J Loud Individual Corporate Director Mar 21, 2024
Wendy Fielding Individual Corporate Officer Dec 2, 2021
Emily Phyllis Zeitler Individual Corporate Director Jan 1, 2025
Mark Speers Individual Corporate DirectorBoard Member Jan 1, 2023
Laura M Chiang Individual Corporate DirectorBoard Member Jan 1, 2023
John Muhlen Individual Corporate Director Oct 1, 2023
W-2 Managing Employee Oct 1, 2023
Sherri C Oberg Individual Corporate DirectorBoard Member Jan 1, 2022
Barbara Moore Individual Contracted Managing EmployeeAr Management Director II Jun 1, 2015
Corporate DirectorAr Management Director II Jun 1, 2015
Nancy M Dunbar Individual Corporate DirectorBoard Member Jan 1, 2022
Marcus P Coe Individual Corporate DirectorMD, Ms, Board Member Jan 1, 2024
Gary V Desir Individual Corporate DirectorBoard Member Jan 1, 2023
Mary Elyse Allan Individual Corporate DirectorC.M., Board Member Jan 1, 2024

Owners & managing parties with NPI records 6

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

Practitioners & affiliated clinicians

Practitioners 2,890

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 2,890

Affiliated clinicians 2,539

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 2,539

NPI Registry JSON

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788134400000",
    "number": "1023092053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 419112",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022419112",
            "telephone_number": "603-650-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ONE MEDICAL CENTER DR",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037560001",
            "telephone_number": "603-650-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY HITCHCOCK MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-02",
        "last_updated": "2026-08-31",
        "certification_date": "2026-08-31",
        "status": "A",
        "authorized_official_last_name": "JANTZEN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "603-650-5668",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NH",
            "license": "01799",
            "primary": false
        },
        {
            "code": "261QE0002X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Emergency Care",
            "state": "NH",
            "license": "01799",
            "primary": false
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": "NH",
            "license": "01799",
            "primary": false
        },
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NH",
            "license": "01799",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NH",
            "license": "01799",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NH",
            "license": "01799",
            "primary": false
        },
        {
            "code": "3416A0800X",
            "taxonomy_group": "",
            "desc": "Ambulance, Air Transport",
            "state": "VT",
            "license": "0920",
            "primary": false
        },
        {
            "code": "3416A0800X",
            "taxonomy_group": "",
            "desc": "Ambulance, Air Transport",
            "state": "NH",
            "license": "0296",
            "primary": false
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
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            "identifier": "3076533",
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        },
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            "identifier": "30210001",
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        },
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            "identifier": "30011095",
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            "issuer": null,
            "identifier": "80300003",
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        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DE1531",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CD9167",
            "state": "NH"
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            "identifier": "0300003",
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            "identifier": "0300900",
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            "issuer": null,
            "identifier": "80300900",
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    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lebanon, NH

Sources for this page

Verify at the official NPI Registry.