NPIMap

Organization Active NPI

Springfield Medical Care Systems Inc

  • Federally Qualified Health Center (FQHC)
  • Springfield, VT
National Provider Identifier
1205291317
Registry record updated Oct 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SPRINGFIELD MEDICAL CARE SYSTEMS INC
Practice address
100 River St
Springfield, VT 05156-2930
Phone
(802) 886-3937
NPI assigned
Dec 17, 2015
Last updated
Oct 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2024

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

Authorized official

Name
Andrew Majka
Title
Cfo
Phone
(802) 886-8950

Specialties & licenses 1

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

Addresses

Primary practice location

100 River St
Springfield, VT 05156-2930

Mailing address

PO Box 710
Springfield, VT 05156-0710
Phone (802) 886-8950

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160210002076 VT Part A Provider - Federally Qualified Health Center (FQHC) 9133157043 Practice locations: North Springfield, VT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205291317. Details of each certification follow.

Federally qualified health center certification: CCN 471860

Legal name
SPRINGFIELD MEDICAL CARE SYSTEMS INC
Doing business as
LANE EYE ASSOCIATES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 17, 2016
Last certification
Mar 17, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 12, 1982 in VT
Enrollment address
441 River St
North Springfield, VT 51509756

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Springfield Medical Care Systems Inc17 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 11

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

NameRoleSinceShare
Stephen J Varone Individual Corporate Director Dec 8, 2020 100%
Cheryl a Sanctuary Individual Corporate Director Jan 6, 2021 100%
Susan P White Individual Corporate Director Oct 26, 2021 100%
Andrew J Majka Individual Corporate OfficerCfo Jan 1, 2023 100%
Kendra E Ingalls Individual Corporate Director Feb 8, 2019 100%
W-2 Managing Employee Feb 8, 2019 100%
Joshua R Dufresne Individual Corporate OfficerCeo Dec 1, 2018 100%
W-2 Managing EmployeeCeo Dec 1, 2018 100%
Jennifer L Anderson Individual Corporate Director Oct 26, 2021 100%
Anthony P Petrillo Individual Corporate Director Dec 8, 2020 100%
Amanda M McLeod Individual Corporate Director Jan 1, 2023 100%
Edmond H Moore Individual Corporate Director Dec 28, 2020 100%
Kelly M Pajala Individual Corporate Director Oct 26, 2021 100%

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Springfield Hospital Inc.Springfield, VT, CCN 471306 Hospital 5% Or Greater Indirect Ownership Interest (100%) May 12, 1982
Springfield Hospital Inc.Springfield, VT, CCN 47Z306 Hospital 5% Or Greater Indirect Ownership Interest (100%) May 12, 1982

Owned or controlled facilities with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1450310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729728000000",
    "number": "1205291317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 710",
            "city": "SPRINGFIELD",
            "state": "VT",
            "postal_code": "051560710",
            "telephone_number": "802-886-8950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 RIVER ST",
            "city": "SPRINGFIELD",
            "state": "VT",
            "postal_code": "051562930",
            "telephone_number": "802-886-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRINGFIELD MEDICAL CARE SYSTEMS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-17",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A",
        "authorized_official_last_name": "MAJKA",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "802-886-8950"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, VT

Sources for this page

Verify at the official NPI Registry.