NPIMap

Organization Active NPI

Mid-State Health Center

  • Federally Qualified Health Center (FQHC)
  • Plymouth, NH
National Provider Identifier
1285279182
Registry record updated Nov 2, 2023
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
28 Main St
Plymouth, NH 03264-1440
Phone
(603) 536-4000
NPI assigned
Nov 14, 2019
Last updated
Nov 2, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

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 NU Primary

Addresses

Primary practice location

28 Main St
Plymouth, NH 03264-1440

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
O20200416000894 NH Part A Provider - Federally Qualified Health Center (FQHC) 1951363563 Practice locations: Plymouth, NH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285279182. Details of each certification follow.

Federally qualified health center certification: CCN 301838

Legal name
MID-STATE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 16, 2020
Last certification
Apr 16, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 14, 2019 in NH
Enrollment address
28 Main St
Plymouth, NH 32641440

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
Sma Bristol17 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

Locations

101 Boulder Point Dr
Ste 1
Plymouth, NH 03264
Phone (603) 238-3537

Ownership & related parties

All disclosed owners & managing parties 8

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 Director Dec 19, 2017
Chelsea R Salomon Individual Corporate DirectorBoard Member Feb 23, 2021
Michael Long Individual Corporate Director May 28, 2019
Peter Laufenberg Individual Corporate Director Dec 27, 2016
Robert J Macleod Individual Corporate OfficerChief Executive Officer Oct 1, 2018
W-2 Managing EmployeeChief Executive Officer Oct 1, 2018
Joseph Monti Individual Corporate Director Jul 23, 2019
Benoit Leon Lamontagne Individual Corporate DirectorBoard Member Jun 22, 2021
William a Sweeney Individual Corporate OfficerChief Financial Officer Jan 1, 2000
W-2 Managing Employee Jun 25, 2007

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
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": "1573689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698883200000",
    "number": "1285279182",
    "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",
            "fax_number": "603-536-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 MAIN ST",
            "city": "PLYMOUTH",
            "state": "NH",
            "postal_code": "032641440",
            "telephone_number": "603-536-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-STATE HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-14",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, NH

Sources for this page

Verify at the official NPI Registry.