NPIMap

Organization Active NPI

Wentworth Douglass Hospital

  • Clinical Medical Laboratory
  • Dover, NH
National Provider Identifier
1124496823
Registry record updated Dec 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
WENTWORTH DOUGLASS HOSPITAL
Practice address
789 Central Ave
Dover, NH 03820
Phone
(603) 742-5252
NPI assigned
Sep 11, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2025

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

Authorized official

Name
Joel Degenaars
Title
Executive Director of Finance
Phone
(603) 740-2806

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

789 Central Ave
Dover, NH 03820

Mailing address

PO Box 412540
Boston, MA 02241-2540

Other identifiers 1

IdentifierTypeStateIssuer
3074430MedicaidNH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040730000120 NH Part B Supplier - Clinic/Group Practice 9234047762 Receives reassigned benefits from 4 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dover, NH; Somersworth, NH; Rochester, NH; Portsmouth, NH; Lee, NH; Durham, NH

Other NPIs on the same Medicare enrollment 11

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

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
30D0087112Wentworth Douglass Hospital Laboratory789 Central Ave, Dover, NH 03820AccreditationFeb 12, 2027
30D0866896Wentworth-Douglass Hosp/Pulmonary Med789 Central Ave, Dover, NH 03820AccreditationFeb 8, 2027
30D0950655Wentworth Douglass Hospital789 Central Ave, Dover, NH 03820Certificate of waiverSep 7, 2026
30D2023290Wentworth Doulgass Hospital Women'S and Children789 Central Ave, Dover, NH 03820Provider-performed microscopyApr 19, 2027

National Provider Directory

National Provider Directory
Tax ID family
Scott J Low DO17 organizations share this tax ID, including this one
Part of
Scott J Low DO

Other organizations with this tax ID 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1441929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765929600000",
    "number": "1124496823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 412540",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022412540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "789 CENTRAL AVE",
            "city": "DOVER",
            "state": "NH",
            "postal_code": "03820",
            "telephone_number": "603-742-5252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WENTWORTH DOUGLASS HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-11",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A",
        "authorized_official_last_name": "DEGENAARS",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "603-740-2806"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3074430",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dover, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.