NPIMap

Organization Active NPI

Northern Counties Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • St Johnsbury, VT
National Provider Identifier
1295852549
Registry record updated Jun 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHERN COUNTIES HEALTH CARE, INC.
Practice address
185 Sherman Dr
St Johnsbury, VT 05819-9811
Phone
(802) 695-2512
Fax
(802) 695-1303
NPI assigned
Mar 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2021

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

Authorized official

Name
Michael Costa
Title
Executive Director/Ceo
Phone
(802) 748-9405

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Health Service Clinic/Center 261QH0100X
Clinical Medical Laboratory 291U00000X

Addresses

Primary practice location

185 Sherman Dr
St Johnsbury, VT 05819-9811

Mailing address

165 Sherman Drive
St Johnsbury, VT 05819
Phone (802) 748-9405

Other practice location 1

201 East Main St
Concord, VT 05824
Phone (802) 695-2512

Other identifiers 2

IdentifierTypeStateIssuer
471801OtherVTMEDICARE PROVIDER NUMBER
0473807MedicaidVT

Other names 1

  • Concord Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100601000677 VT Part A Provider - Federally Qualified Health Center (FQHC) 2860300936 Practice locations: Concord, VT

Federally qualified health center certification: CCN 471801

Legal name
NORTHERN COUNTIES HEALTH CARE INC
Doing business as
CONCORD HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Sep 19, 1976 in VT
Enrollment address
201 E Main St
Concord, VT 58240355

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Hardwick Area HLTH Cent17 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 12

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

NameRoleSinceShare
Angela Neil Individual Corporate OfficerCfo Feb 1, 2021
Thaddeus R Richardson Individual Corporate DirectorBoard Member Sep 26, 2012
Nancy Reynolds Individual Corporate DirectorBoard Member May 23, 2018
Michael K Costa Individual Corporate Officer Apr 1, 2019
W-2 Managing EmployeeCeo Apr 1, 2019
Karena Shippee Individual Corporate DirectorBoard Member Jun 22, 2016
Cynthia S Stuart Individual Corporate DirectorBoard Member Jan 24, 2018
Laurel Ruggles Individual Corporate DirectorBoard Member Sep 25, 2013
Caroline Frey Individual Corporate DirectorBoard Member Oct 19, 2014
Alan Cronauer Individual Corporate DirectorBoard Member Aug 23, 2017
Marie Waring Individual Corporate DirectorBoard Member Jun 22, 2016
Ronald Steen Individual Corporate DirectorBoard Member Feb 24, 2016
Katherine Gent Individual Corporate DirectorBoard Member Feb 24, 2016

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 49

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 49

NPI Registry JSON

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623369600000",
    "number": "1295852549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 SHERMAN DRIVE",
            "city": "ST JOHNSBURY",
            "state": "VT",
            "postal_code": "05819",
            "telephone_number": "802-748-9405",
            "fax_number": "802-748-4540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 SHERMAN DR",
            "city": "ST JOHNSBURY",
            "state": "VT",
            "postal_code": "058199811",
            "telephone_number": "802-695-2512",
            "fax_number": "802-695-1303"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 East Main St",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "VT",
            "postal_code": "05824",
            "country_code": "US",
            "telephone_number": "802-695-2512",
            "fax_number": "802-695-1303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHERN COUNTIES HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2021-06-11",
        "certification_date": "2021-06-11",
        "status": "A",
        "authorized_official_last_name": "COSTA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR/CEO",
        "authorized_official_telephone_number": "802-748-9405"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "471801",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0473807",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Concord Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Concord Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Johnsbury, VT

Sources for this page

Verify at the official NPI Registry.