Porter Hospital Dba Cedar Ledge Family Practice
Organization Active NPI Family Medicine Physician · Middlebury, VT
NPI 1144240474 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1144240474
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- PORTER HOSPITAL DBA CEDAR LEDGE FAMILY PRACTICE
- Practice address
- 99 Court St
Cedar Lodge Family Practice
Middlebury, VT 05753-1408 - Phone
- (802) 388-7185
- Fax
- (802) 388-3445
- NPI assigned
- Jul 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Duncan S Brines, CFO
- Title
- Cfo
- Phone
- (802) 388-4701
Other NPIs on the same Medicare enrollment 16
Related certifications (CCN) 1
Affiliated clinicians 468
-
Jeffrey Peter Abell, PA-C
-
Steven Ades, MD
-
Devon Eric Anderson, MD, PHD
-
Scott Robert Anderson, M.D.
-
Rahul Anil, MD
-
Charles Warner Ashley, M.D.
-
Alia Frances Aunchman, M.D.
-
Catherine Anne Ayers, M.D.
-
Lisa Deuel Baker, MD
-
Dragos Banu, M.D.
-
Maura Barry, MD
-
Brian D. Bates, MD
Medicare Care Compare: Hospital
- Listed as
- Porter Hospital Inc
- Overall star rating
- ★★★☆☆ 3 of 5
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VT
Hospital certification: CCN 471307
- Legal name
- PORTER HOSPITAL INC
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Dec 31, 2005
- Last certification
- Mar 16, 2022
- Beds
- 45
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 14, 1986 in VT
- Enrollment address
- 115 Porter Dr
Middlebury, VT 57538423
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Sivan Cotel |
Corporate Director |
Oct 1, 2018 | |
| Porter Medical Center Inc |
Operational/Managerial Control | Nov 14, 1986 | |
| William J Townsend |
Corporate Director | Jan 1, 2009 | |
| Thomas Thompson |
Corporate Officer |
Jan 1, 2021 | 100% |
| Elizabeth Elkins |
W-2 Managing Employee | Jan 1, 2021 | |
| Scott a Comeau |
Corporate Officer |
Jan 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050919000862 | VT | Part B Supplier - Clinic/Group Practice | 1850365180 |
Receives reassigned benefits from 379 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Vergennes, VT; Rutland, VT; Middlebury, VT; Brandon, VT |
| O20061104000607 | VT | Part a Provider - Critical Access Hospital | 1850365180 |
Receives reassigned benefits from 246 practitioners 16 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Middlebury, VT; Vergennes, VT; Rutland, VT; Bristol, VT; Brandon, VT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
99 Court St
Cedar Lodge Family Practice
Middlebury, VT 05753-1408
Mailing address
104 Porter Dr
Middlebury, VT 05753-8527
Phone (802) 388-8808
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0VN1355 | Medicaid | VT |
Other providers in Middlebury, VT
- Shawna Ploof
- Irene Poole
- Porter Health Systems, Inc.
- Porter Hospital
- Porter Hospital Dba Addison Family Health
- Porter Hospital Inc
- Porter Hospital Inc
- Porter Hospital Inc
- Porter Hospital Inc
- Porter Hospital Inc
All providers in Middlebury, 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 Aug 22, 2020. 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.