NPIMap

Organization Active NPI

Island Health Inc.

Doing business as Island Health Care

  • Rural Health Clinic/Center
  • Edgartown, MA
National Provider Identifier
1316077464
Registry record updated Mar 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
4XHU Issued in MA
Legal business name
ISLAND HEALTH INC.
Doing business as
Island Health Care
Practice address
245 Vineyard Haven-Edgartown Road
Edgartown, MA 02539
Phone
(508) 939-9358
NPI assigned
Mar 7, 2007
Last updated
Mar 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2024

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

Authorized official

Name
Cynthia Mitchell
Title
Executive Director
Phone
(508) 627-5797

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 4XHU MA Primary

Addresses

Primary practice location

245 Vineyard Haven-Edgartown Road
Edgartown, MA 02539

Mailing address

PO Box 1619
West Tisbury, MA 02575-1619
Phone (508) 627-5797

Other names 1

  • Island Health Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20151103000033 MA Part B Supplier - Clinic/Group Practice 3779562376 Receives reassigned benefits from 15 practitioners
Practice locations: Edgartown, MA
O20161230001106 MA Part A Provider - Federally Qualified Health Center (FQHC) 3779562376 Practice locations: Edgartown, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316077464. Details of each certification follow.

Federally qualified health center certification: CCN 221941

Legal name
ISLAND HEALTH INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 6, 2017
Last certification
Jan 6, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 21, 2002 in MA
Enrollment address
245 Edgartown Vineyard Haven Rd
Edgartown, MA 25396941

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10031202

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
Matthew Stackpole Individual Corporate OfficerChairman Jan 10, 2015 5%
Joao Ribeiro Individual Corporate DirectorDirector Jan 17, 2014 5%
Edmilson Rosado Individual Corporate DirectorDirector Jan 9, 2015 5%
Cynthia Mitchell Individual Corporate Officer Jun 21, 2002
W-2 Managing EmployeeCeo Jun 21, 2002 55%
Judy Elmer Individual Corporate OfficerVice Chair Jan 10, 2015 5%
Margaret Harris Individual Corporate DirectorDirector Apr 20, 2015 5%
Nancy E Langman Individual Corporate DirectorDirector Jan 10, 2015 5%
Mark Mazer Individual Corporate DirectorDirector Jan 8, 2015 5%

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711584000000",
    "number": "1316077464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1619",
            "city": "WEST TISBURY",
            "state": "MA",
            "postal_code": "025751619",
            "telephone_number": "508-627-5797",
            "fax_number": "508-627-5799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 VINEYARD HAVEN-EDGARTOWN ROAD",
            "city": "EDGARTOWN",
            "state": "MA",
            "postal_code": "02539",
            "telephone_number": "508-939-9358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND HEALTH INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-28",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "508-627-5797"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MA",
            "license": "4XHU",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Island Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edgartown, MA

Sources for this page

Verify at the official NPI Registry.