NPIMap

Organization Active NPI

Gifford Health Care, Inc

Doing business as Gifford Health Center at Berlin

  • Federally Qualified Health Center (FQHC)
  • Barre, VT
National Provider Identifier
1184054009
Registry record updated Jul 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GIFFORD HEALTH CARE, INC
Doing business as
Gifford Health Center at Berlin
Practice address
2418 Airport Rd Ste 1
Barre, VT 05641-8702
Phone
(802) 229-2325
Fax
(802) 229-4572
NPI assigned
Nov 13, 2013
Last updated
Jul 1, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
GIFFORD HEALTH CARE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 1, 2025

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

Authorized official

Name
Michael K Costa
Title
Ceo
Phone
(802) 728-2211

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X VT Primary

Addresses

Primary practice location

2418 Airport Rd Ste 1
Barre, VT 05641-8702

Mailing address

44 S Main St
Randolph, VT 05060-1381
Phone (802) 728-7000

Other names 1

  • Gifford Health Center at Berlin Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140409001352 VT Part A Provider - Federally Qualified Health Center (FQHC) 2668624982 Practice locations: Barre, VT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184054009. Details of each certification follow.

Federally qualified health center certification: CCN 471853

Legal name
GIFFORD HEALTH CARE INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 28, 2014
Last certification
Apr 28, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 23, 2012 in VT
Enrollment address
2418 Airport Rd
Ste 1
Barre, VT 56418702

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
Gifford Health Care Inc10 organizations share this tax ID, including this one
Part of
Gifford Health Care Inc

Other organizations with this tax ID 9

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

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Kathleen Mason Individual Operational/Managerial ControlBoard Member Jan 1, 2025
Jody Davignon Individual Operational/Managerial Control Jan 1, 2022
Michael K Costa Individual Corporate DirectorCeo Oct 3, 2024
Victor Ribaudo Individual Operational/Managerial Control Jan 1, 2022
Cheyenne Holland Individual Corporate OfficerCfo Aug 19, 2024
Jeffrey J Nelb Individual Operational/Managerial ControlBoard Member Jan 1, 2025
Paul Putney Individual Operational/Managerial ControlBoard Member Jan 1, 2025
Kristin Chandler Individual Operational/Managerial Control Jan 1, 2022
Cindy Rosalbo Individual Operational/Managerial ControlBoard Member Jan 1, 2025
Sarah Jackson Individual Operational/Managerial Control Jan 1, 2022
Morgan Rilling Individual Operational/Managerial Control Jan 1, 2022
Jamie Kinnarney Individual Operational/Managerial ControlBoard Member Jan 1, 2025
Peter Reed Individual Operational/Managerial Control Jan 1, 2022
Emilija O Florance Individual Operational/Managerial ControlBoard Member Apr 30, 2023
Matthew Considine Individual Other Dec 19, 2013

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Menig Nursing HomeRandolph Ctr, VT, CCN 475058 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Trustee of the SNF
Adp of the SNF
Direct Ownership Interest (100%)		 Aug 12, 2013
Aug 12, 2013
Aug 12, 2013
Aug 12, 2013

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Gifford Retirement Community, Inc

    dba Menig Nursing Home

    • Nursing Facility/Intermediate Care Facility
    • Randolph, VT
    • NPI 1366832230

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Direct Ownership Interest, Trustee of the SNF

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1384300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751328000000",
    "number": "1184054009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 S MAIN ST",
            "city": "RANDOLPH",
            "state": "VT",
            "postal_code": "050601381",
            "telephone_number": "802-728-7000",
            "fax_number": "802-728-4245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2418 AIRPORT RD STE 1",
            "city": "BARRE",
            "state": "VT",
            "postal_code": "056418702",
            "telephone_number": "802-229-2325",
            "fax_number": "802-229-4572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIFFORD HEALTH CARE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GIFFORD HEALTH CARE, INC",
        "enumeration_date": "2013-11-13",
        "last_updated": "2025-07-01",
        "certification_date": "2025-07-01",
        "status": "A",
        "authorized_official_last_name": "COSTA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "802-728-2211"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "VT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gifford Health Center at Berlin",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gifford Health Center at Berlin",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Barre, VT

Sources for this page

Verify at the official NPI Registry.