NPIMap

Organization Active NPI

Community Health Centers of the Rutland Region, Inc.

  • Federally Qualified Health Center (FQHC)
  • Rutland, VT
National Provider Identifier
1225400237
Registry record updated Feb 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION, INC.
Practice address
71 Allen Pond
Suite 403
Rutland, VT 05701-4570
Phone
(802) 772-7992
Fax
(802) 772-7973
NPI assigned
Oct 29, 2015
Last updated
Feb 17, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 17, 2025

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

Authorized official

Name
Michael Gardner
Title
Ceo
Phone
(802) 855-2083

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Optometrist 152W00000X
Family Medicine Physician 207Q00000X
Ophthalmology Physician 207W00000X

Addresses

Primary practice location

71 Allen Pond
Suite 403
Rutland, VT 05701-4570

Mailing address

71 Allen St
Suite 101
Rutland, VT 05701-4570
Phone (800) 468-9118

Other identifiers 1

IdentifierTypeStateIssuer
1025859MedicaidVT

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100804000784 VT Part B Supplier - Clinic/Group Practice 2961467386 Receives reassigned benefits from 150 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rutland, VT; Shoreham, VT
O20151112001320 VT Part A Provider - Federally Qualified Health Center (FQHC) 2961467386 Practice locations: Rutland, VT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225400237. Details of each certification follow.

Federally qualified health center certification: CCN 471865

Legal name
COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION INC
Doing business as
ALLEN POND FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 30, 2017
Last certification
Jun 30, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 1, 2015 in VT
Enrollment address
71 Allen St
Ste 403
Rutland, VT 57014570

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Part of
Community Health Centers of the Rutland Region

Locations

231 N Main St
Rutland, VT 05701
Phone (800) 468-9118

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Robert Hedden Individual Corporate Director Jan 1, 2025
Joanne Calvi Individual Corporate DirectorBoard Member Mar 1, 2011 6.25%
Robert Riley Individual Corporate DirectorBoard Member Feb 28, 2017
Amy Menard Individual Corporate DirectorBoard Member Jan 14, 2014 6.25%
Charles Becker Individual Corporate Director Jan 1, 2025
Chadd Viger Individual Corporate Director Jan 1, 2025
Michael Gardner Individual Corporate DirectorChief Financial Officer May 1, 2019 6.25%
W-2 Managing EmployeeChief Financial Officer May 1, 2019 6.25%
Matthew Whitcomb Individual Corporate Director Jan 1, 2025
Richard Griffith Individual Corporate DirectorBoard Member Jun 1, 2006 6.25%
Nancy Morlino Individual Corporate DirectorBoard Member Jan 22, 2019 6.5%
Lawrence Jensen Individual Corporate DirectorBoard Member Sep 1, 2003 6.25%
Damien Barnes Individual Corporate DirectorBoard Member Jul 1, 2023
Elizabeth Kyhill Individual Corporate DirectorBoard Member Sep 1, 2023
Carol Ballou Individual Corporate DirectorBoard Member Jul 25, 2017
Jade Mead Individual Corporate DirectorBoard Member Nov 1, 2021
Jennifer L Scott Individual Corporate DirectorBoard Member Dec 1, 2023
Luther Brown Individual Corporate DirectorBoard Member Jun 30, 2021
Joseph Kraus Individual Corporate Director Jan 1, 2025

Practitioners & affiliated clinicians

Practitioners 60

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.

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1446076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739750400000",
    "number": "1225400237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 ALLEN ST",
            "address_2": "SUITE 101",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014570",
            "telephone_number": "800-468-9118",
            "fax_number": "802-772-7973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 ALLEN POND",
            "address_2": "SUITE 403",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014570",
            "telephone_number": "802-772-7992",
            "fax_number": "802-772-7973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION, INC.",
        "enumeration_date": "2015-10-29",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "802-855-2083"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1025859",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rutland, VT

Sources for this page

Verify at the official NPI Registry.