NPIMap

Organization Active NPI

Community Health Centers of the Rutland Region, Inc.

Doing business as dba Mettowee Valley Family Health Center

  • Family Medicine Physician
  • West Pawlet, VT
National Provider Identifier
1104870922
Registry record updated Sep 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION, INC.
Doing business as
dba Mettowee Valley Family Health Center
Practice address
278 VT Route 149
West Pawlet, VT 05775-9798
Phone
(802) 645-0580
Fax
(802) 645-0587
NPI assigned
May 19, 2006
Last updated
Sep 11, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2018

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

Authorized official

Name
Michael L Gardner
Title
Finance Director
Phone
(802) 855-2080

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
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 names 1

  • dba Mettowee Valley Family Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104870922. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Mar 26, 2004 in VT
Enrollment address
278 VT Route 149
West Pawlet, VT 57759798

Other NPIs with the same Medicare PAC ID 8

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
47D0855643Chcrr - Mettowee Valley Family Health Ctr278 VT Rte 149, West Pawlet, VT 05775Provider-performed microscopyDec 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Robert Hedden Individual Corporate Director Jan 1, 2025
Joanne Calvi Individual Corporate DirectorBoard Member Mar 1, 2011 6.25%
Robert Riley Individual Corporate DirectorBoard Member Feb 28, 2017
Amy Menard Individual Corporate DirectorBoard Member Jan 14, 2014 6.25%
Charles Becker Individual Corporate Director Jan 1, 2025
Chadd Viger Individual Corporate Director Jan 1, 2025
Michael Gardner Individual Corporate DirectorChief Financial Officer May 1, 2019 6.25%
W-2 Managing EmployeeChief Financial Officer May 1, 2019 6.25%
Matthew Whitcomb Individual Corporate Director Jan 1, 2025
Richard Griffith Individual Corporate DirectorBoard Member Jun 1, 2006 6.25%
Nancy Morlino Individual Corporate DirectorBoard Member Jan 22, 2019 6.5%
Lawrence Jensen Individual Corporate DirectorBoard Member Sep 1, 2003 6.25%
Damien Barnes Individual Corporate DirectorBoard Member Jul 1, 2023
Elizabeth Kyhill Individual Corporate DirectorBoard Member Sep 1, 2023
Carol Ballou Individual Corporate Director Jul 25, 2017
Jade Mead Individual Corporate DirectorBoard Member Nov 1, 2021
Jennifer L Scott Individual Corporate DirectorBoard Member Dec 1, 2023
Luther Brown Individual Corporate Director Jun 30, 2021
Joseph Kraus Individual Corporate Director Jan 1, 2025

Practitioners & affiliated clinicians

Practitioners 140

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 140

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536624000000",
    "number": "1104870922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 ALLEN ST",
            "address_2": "SUITE 403",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014570",
            "telephone_number": "802-772-4414",
            "fax_number": "802-772-7973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "278 VT ROUTE 149",
            "city": "WEST PAWLET",
            "state": "VT",
            "postal_code": "057759798",
            "telephone_number": "802-645-0580",
            "fax_number": "802-645-0587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2018-09-11",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "802-855-2080"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dba Mettowee Valley Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "dba Mettowee Valley Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Pawlet, VT

Sources for this page

Verify at the official NPI Registry.