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Speare Memorial Hospital

Organization Active NPI Ophthalmology Physician · Plymouth, NH

NPI 1104153535 · NPPES record last updated Dec 3, 2020

Key facts

NPI
1104153535
Entity type
Organization (NPI type 2)
Primary specialty
Ophthalmology Physician 207W00000X
Legal business name
SPEARE MEMORIAL HOSPITAL
Practice address
103 Boulder Point Drive
Plymouth, NH 03264-3168
Phone
(603) 536-1284
Fax
(603) 536-3136
NPI assigned
Nov 5, 2009
Organization subpart
Yes
Parent organization (as reported)
SPEARE MEMORIAL HOSPITAL

Authorized official

Name
Michelle L McEwen
Title
President/Ceo
Phone
(603) 536-1120

Other NPIs with the same Medicare PAC ID 11

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

Corporate family (same tax ID) 8

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

Practitioners 49

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

View all 49

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NH

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100226000358 NH Part B Supplier - Clinic/Group Practice 1153318068 Receives reassigned benefits from 2 practitioners
Practice locations: Plymouth, NH

National Provider Directory

Tax ID family
Sceva Speare Pathology (9 organizations share this tax ID)
Part of
Sceva Speare Pathology

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist
Group: 193200000X MULTI-SPECIALTY GROUP		 152W00000X
Ophthalmology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207W00000X Yes

Addresses

Primary practice location

103 Boulder Point Drive
Plymouth, NH 03264-3168

Mailing address

16 Hospital Rd
Plymouth, NH 03264-1126
Phone (603) 238-2204

Other identifiers

IdentifierTypeStateIssuer
1017117MedicaidVT
3076997MedicaidNH

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 3, 2020.

{
    "created_epoch": "1257379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606953600000",
    "number": "1104153535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 HOSPITAL RD",
            "city": "PLYMOUTH",
            "state": "NH",
            "postal_code": "032641126",
            "telephone_number": "603-238-2204",
            "fax_number": "603-536-2034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 BOULDER POINT DRIVE",
            "city": "PLYMOUTH",
            "state": "NH",
            "postal_code": "032643168",
            "telephone_number": "603-536-1284",
            "fax_number": "603-536-3136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPEARE MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPEARE MEMORIAL HOSPITAL",
        "enumeration_date": "2009-11-05",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A",
        "authorized_official_last_name": "MCEWEN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "603-536-1120"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1017117",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3076997",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, NH

All providers in Plymouth, NH · Ophthalmology Physician in New Hampshire

Sources for this page

Verify at the official NPI Registry.