NPIMap

Organization Active NPI

Mid-State Health Center

  • Federally Qualified Health Center (FQHC)
  • Lincoln, NH
National Provider Identifier
1194464982
Registry record updated Jun 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MID-STATE HEALTH CENTER
Practice address
6 South Mountain Drive
Lincoln, NH 03251
Phone
(603) 536-4000
NPI assigned
Jun 1, 2022
Last updated
Jun 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2022

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

Authorized official

Name
William Albert Sweeney
Title
Cfo
Phone
(603) 536-4000

Specialties & licenses 1

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

Addresses

Primary practice location

6 South Mountain Drive
Lincoln, NH 03251

Mailing address

101 Boulder Point Dr Ste 1
Plymouth, NH 03264-3170
Phone (603) 536-4000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220823003722 NH Part A Provider - Federally Qualified Health Center (FQHC) 1951363563 Practice locations: Lincoln, NH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194464982. Details of each certification follow.

Federally qualified health center certification: CCN 301858

Legal name
MID-STATE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 15, 2022
Last certification
Aug 15, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
6 S Mountain Rd
Lincoln, NH 32514268

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Speare Medical Associat17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Louis Bickford Individual Corporate DirectorBoard of Directors Dec 19, 2017
Nicholas Coates Individual Corporate DirectorDirector May 21, 2018
Isaac Davis Individual Corporate DirectorDirector Feb 26, 2019
Michael Long Individual Corporate DirectorDirector May 28, 2019
Peter Laufenberg Individual Corporate DirectorDirector Dec 27, 2016
Robert J Macleod Individual Corporate OfficerCeo Jun 18, 2018
W-2 Managing EmployeeCeo Jun 18, 2018
Joseph Monti Individual Corporate DirectorDirector Jul 23, 2019
Carina Park Individual Corporate DirectorDirector Apr 24, 2019
William a Sweeney Individual Corporate OfficerCfo Jan 1, 1998

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Mid-State Health CenterPlymouth, NH, CCN 301817 Federally qualified health center Operational/Managerial Control Jan 9, 1998

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1654041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654041600000",
    "number": "1194464982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BOULDER POINT DR STE 1",
            "city": "PLYMOUTH",
            "state": "NH",
            "postal_code": "032643170",
            "telephone_number": "603-536-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 SOUTH MOUNTAIN DRIVE",
            "city": "LINCOLN",
            "state": "NH",
            "postal_code": "03251",
            "telephone_number": "603-536-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-STATE HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-01",
        "last_updated": "2022-06-01",
        "certification_date": "2022-05-17",
        "status": "A",
        "authorized_official_last_name": "SWEENEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "ALBERT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "603-536-4000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, NH

Sources for this page

Verify at the official NPI Registry.