Community Health Centers of the Rutland Region, Inc.
Organization Active NPI Family Medicine Physician · West Pawlet, VT
NPI 1104870922 · NPPES record last updated Sep 11, 2018
Key facts
- NPI
- 1104870922
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION, INC.
- Practice address
- 278 VT Route 149
West Pawlet, VT 05775-9798 - Phone
- (802) 645-0580
- Fax
- (802) 645-0587
- NPI assigned
- May 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Michael L Gardner
- Title
- Finance Director
- Phone
- (802) 855-2080
Other NPIs with the same Medicare PAC ID 8
Practitioners 159
-
Folake Azeez, PMHNP
-
Sally J Beayon, FNP-C
-
Carl E Beckler, MD
-
Jennifer A Broomfield, LCSW
-
Krystal J Brown, LICSW
-
Lisa E Brown, LICSW
-
Samuel Joseph Cahill, PA-C
-
Katherine Cardenas, LCDC
-
Ayla Lewis Carr, FNP-C
-
Jordan David Carr, PA-C
-
Sarah Elizabeth Christiana, DNP, FNP-BC
-
Laurie A Coombs, MSW, LCSW
-
Kayla W Cummings, APRN
-
Lisa S Cushing, P.A.
-
John F Dick II, MD
-
Amanda K Domingus, APRN
-
Kassia Ann Dutton, APRN
-
Sarah Hart Dwyer, APRN
-
Andre Jermaine Eason Jr., LADC, LCMHC
-
Laura G Ethier, LICSW
-
Julie A Foster, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 47D0855643 | Chcrr - Mettowee Valley Family Health Ctr | Provider-performed microscopy | Dec 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VT
Federally qualified health center certification: CCN 471816
- Legal name
- COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION INC
- Doing business as
- METTOWEE VALLEY FAMILY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Apr 24, 2006
- Last certification
- Apr 24, 2006
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 26, 2004 in VT
- Enrollment address
- 278 VT Route 149
West Pawlet, VT 57759798
All disclosed owners & managing parties 18
| Name | Role | Since | Share |
|---|---|---|---|
| Robert Hedden |
Corporate Director | Jan 1, 2025 | |
| Joanne Calvi |
Corporate Director |
Mar 1, 2011 | 6.25% |
| Robert Riley |
Corporate Director |
Feb 28, 2017 | |
| Amy Menard |
Corporate Director |
Jan 14, 2014 | 6.25% |
| Charles Becker |
Corporate Director | Jan 1, 2025 | |
| Chadd Viger |
Corporate Director | Jan 1, 2025 | |
| Michael Gardner |
Corporate Director |
May 1, 2019 | 6.25% |
| W-2 Managing Employee |
May 1, 2019 | 6.25% | |
| Matthew Whitcomb |
Corporate Director | Jan 1, 2025 | |
| Richard Griffith |
Corporate Director |
Jun 1, 2006 | 6.25% |
| Nancy Morlino |
Corporate Director |
Jan 22, 2019 | 6.5% |
| Lawrence Jensen |
Corporate Director |
Sep 1, 2003 | 6.25% |
| Damien Barnes |
Corporate Director |
Jul 1, 2023 | |
| Elizabeth Kyhill |
Corporate Director |
Sep 1, 2023 | |
| Carol Ballou |
Corporate Director | Jul 25, 2017 | |
| Jade Mead |
Corporate Director |
Nov 1, 2021 | |
| Jennifer L Scott |
Corporate Director |
Dec 1, 2023 | |
| Luther Brown |
Corporate Director | Jun 30, 2021 | |
| Joseph Kraus |
Corporate Director | Jan 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050131001023 | VT | Part B Supplier - Clinic/Group Practice | 2961467386 |
Receives reassigned benefits from 134 practitioners Practice locations: West Pawlet, VT |
| O20060404000516 | VT | Part a Provider - Federally Qualified Health Center (FQHC) | 2961467386 | Practice locations: West Pawlet, VT |
National Provider Directory
Locations
278 Vt Route 149
West Pawlet, VT 05775
Phone (800) 468-9118
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Federally Qualified Health Center (FQHC) | 261QF0400X |
Addresses
Primary practice location
278 VT Route 149
West Pawlet, VT 05775-9798
Mailing address
71 Allen St
Suite 403
Rutland, VT 05701-4570
Phone (802) 772-4414
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 471816 | Other | VT | NAT'L GOV SERVICES |
| 03044048 | Medicaid | NY | |
| 1010850 | Medicaid | VT |
Other names
- dba Mettowee Valley Family Health Center
Other providers in West Pawlet, VT
- Olga Michelle Arnold
- Jacqueline M Becker
- Carl E Beckler
- Ayla Lewis Carr
- Jordan David Carr
- Michael J Dashnaw
- Green Mountain Speech-Language and Feeding Services, LLC
- Rebecca Kay Heflin
- Rebecca C Hunke
- Diana Lynn Johnson
All providers in West Pawlet, VT · Family Medicine Physician in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.