NPIMap

Organization Active NPI

Catholic Medical Center

  • Federally Qualified Health Center (FQHC)
  • Manchester, NH
National Provider Identifier
1285928259
Registry record updated Oct 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CATHOLIC MEDICAL CENTER
Practice address
177 Lake Ave
Manchester, NH 03103-5321
Phone
(603) 782-7414
Fax
(603) 518-8707
NPI assigned
Jun 7, 2011
Last updated
Oct 23, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2020

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

Authorized official

Name
Edward Dudley
Title
Cfo
Phone
(603) 663-6180

Specialties & licenses 1

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

Addresses

Primary practice location

177 Lake Ave
Manchester, NH 03103-5321

Mailing address

195 McGregor St
Suite LL22
Manchester, NH 03102-3748
Phone (603) 663-8701

Other identifiers 1

IdentifierTypeStateIssuer
30518396MedicaidNH

Other names 1

  • Health Care for the Homeless Program Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cmcnh@gohnh.allscriptsdirect.net Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100719000777 NH Part A Provider - Federally Qualified Health Center (FQHC) 6103897129 1 other NPI on this enrollment
Practice locations: Manchester, NH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285928259. Details of each certification follow.

Federally qualified health center certification: CCN 301823

Legal name
CATHOLIC MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 16, 2010
Last certification
Jun 16, 2010
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 7, 1974 in NH
Enrollment address
177 Lake Ave
Manchester, NH 31035321

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
The Surgical Care Group9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Martha E Maunsell Individual W-2 Managing EmployeeDirector of Budget & Reimbursement Aug 20, 2019
City of Manchester New Hampshire Organization, Manchester, NH Operational/Managerial Control Jun 16, 2010
Timothy Riley Individual OtherBoard Member Jan 24, 2019
John J Munoz Individual OtherBoard Member Apr 20, 2017
Neil Levesque Individual OtherBoard Vice Chair Jan 10, 2014
Derek McDonald Individual OtherBoard Member Jun 27, 2019
Louis I Fink Individual OtherBoard Member Jan 28, 2015
Matthew J Kfoury Individual OtherBoard Secretary Jan 28, 2015
Amy Pratte Individual W-2 Managing EmployeeCatholic Medical Dir. HCH Program Dec 1, 2017
Timothy Soucy Individual W-2 Managing EmployeeCatholic Medical Executive Dir. Sep 6, 2018
Robert a Catania Individual OtherBoard Member Jan 28, 2016
John G Cronin Individual OtherBoard Chair Jan 30, 2013
Catherine Provencher Individual OtherBoard Member Jan 24, 2019
Pamela Diamantis Individual OtherBoard Treasurer Jan 28, 2016
Catholic Medical Center Organization, Manchester, NH Corporation, Non-profit Operational/Managerial Control Jun 16, 2010
Edward L. Dudley Individual Corporate OfficerCatholic Medical VP & Cfo Jan 24, 2011
Joseph Pepe Individual Corporate OfficerCatholic Medical President & Ceo Aug 30, 2012
Carolyn G Claussen Individual OtherBoard Member Jan 28, 2016
Susan M Kinney Individual OtherBoard Member Jan 19, 2018

Owners & managing parties with NPI records 12

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

Owned or controlled facilities with NPI records 1

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": "1307404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603411200000",
    "number": "1285928259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 MCGREGOR ST",
            "address_2": "SUITE LL22",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031023748",
            "telephone_number": "603-663-8701",
            "fax_number": "603-663-8766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "177 LAKE AVE",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031035321",
            "telephone_number": "603-782-7414",
            "fax_number": "603-518-8707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CATHOLIC MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-07",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A",
        "authorized_official_last_name": "DUDLEY",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "603-663-6180"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30518396",
            "state": "NH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cmcnh@gohnh.allscriptsdirect.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "177 Lake Ave",
            "city": "Manchester",
            "state": "NH",
            "country_code": "US",
            "postal_code": "031035321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Health Care for the Homeless Program",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Manchester, NH

Sources for this page

Verify at the official NPI Registry.