NPIMap

Organization Active NPI

Porter Hospital Dba Cedar Ledge Family Practice

  • Family Medicine Physician
  • Middlebury, VT
National Provider Identifier
1144240474
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 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
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Duncan S Brines, CFO
Title
Cfo
Phone
(802) 388-4701

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

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

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144240474. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Nov 14, 1986 in VT
Enrollment address
115 Porter Dr
Middlebury, VT 57538423
Main/Primary Hospital Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 16

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

View all 16

Care Compare: Hospital

Medicare Care Compare
Listed as
Porter Hospital IncCCN 471307 · All quality measures
Overall star rating
3 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Sivan Cotel Individual Corporate DirectorBoard Chairperson Oct 1, 2018
Porter Medical Center Inc Organization, Middlebury, VT Operational/Managerial Control Nov 14, 1986
William J Townsend Individual Corporate Director Jan 1, 2009
Thomas Thompson Individual Corporate OfficerPresident/Coo Jan 1, 2021 100%
Elizabeth Elkins Individual W-2 Managing Employee Jan 1, 2021
Scott a Comeau Individual Corporate OfficerCfo Jan 1, 2024

Practitioners & affiliated clinicians

Affiliated clinicians 468

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 468

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144240474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 PORTER DR",
            "city": "MIDDLEBURY",
            "state": "VT",
            "postal_code": "057538527",
            "telephone_number": "802-388-8808",
            "fax_number": "802-388-8322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 COURT ST",
            "address_2": "CEDAR LODGE FAMILY PRACTICE",
            "city": "MIDDLEBURY",
            "state": "VT",
            "postal_code": "057531408",
            "telephone_number": "802-388-7185",
            "fax_number": "802-388-3445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTER HOSPITAL DBA CEDAR LEDGE FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRINES",
        "authorized_official_first_name": "DUNCAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "802-388-4701",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middlebury, VT

Sources for this page

Verify at the official NPI Registry.