NPIMap

Organization Active NPI

Little Rivers Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Bradford, VT
National Provider Identifier
1316165129
Registry record updated May 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LITTLE RIVERS HEALTH CARE, INC.
Practice address
437 South Main Street
Bradford, VT 05033
Phone
(802) 222-9276
NPI assigned
Apr 24, 2007
Last updated
May 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2023

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

Authorized official

Name
Andrew Barter
Title
Ceo
Phone
(802) 222-9276

Specialties & licenses 1

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

Addresses

Primary practice location

437 South Main Street
Bradford, VT 05033

Mailing address

PO Box 8
Newbury, VT 05051-0008
Phone (802) 222-9276

Other practice location 1

4628 Main Street
Newbury, VT 05051-9712
Phone (802) 866-3000

Other identifiers 2

IdentifierTypeStateIssuer
1012614MedicaidVT
1012615MedicaidVT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060821000281 VT Part A Provider - Federally Qualified Health Center (FQHC) 8224031497 1 other NPI on this enrollment
Practice locations: Bradford, VT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316165129. Details of each certification follow.

Federally qualified health center certification: CCN 471825

Legal name
LITTLE RIVERS HEALTH CARE, INC.
Doing business as
BRADFORD HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 30, 2006
Last certification
Aug 30, 2006
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Aug 12, 2003 in VT
Enrollment address
437 S Main St
Bradford, VT 50339196

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 1

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

National Provider Directory

National Provider Directory
Tax ID family
Little Rivers Health Care12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Carole C Freeman Individual Corporate Officer Jul 29, 2003
Margaret Burmeister Individual Corporate Officer Feb 23, 2009
Matthew Knisley Individual Corporate Director Jan 31, 2018
Andrew I Barter Individual Corporate OfficerCeo Aug 15, 2022
W-2 Managing EmployeeCeo Aug 15, 2022
Operational/Managerial ControlCeo Aug 15, 2022
Jill Skochdopole Individual Corporate DirectorBoard Member Feb 24, 2021
Pamela Smith Individual Corporate Director Dec 20, 2017
Darren Sherburne Individual Corporate DirectorBoard Member Mar 30, 2021
Scott Labun Individual Corporate OfficerBoard Member Jan 30, 2012
Operational/Managerial ControlBoard Member Jan 30, 2012
William a Campbell Individual Corporate OfficerBoard Member Sep 29, 2014
Kelsey Root-Winchester Individual Corporate DirectorBoard Member Mar 25, 2020

NPI Registry JSON

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684886400000",
    "number": "1316165129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8",
            "city": "NEWBURY",
            "state": "VT",
            "postal_code": "050510008",
            "telephone_number": "802-222-9276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "437 SOUTH MAIN STREET",
            "city": "BRADFORD",
            "state": "VT",
            "postal_code": "05033",
            "telephone_number": "802-222-9276"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4628 Main Street",
            "address_purpose": "LOCATION",
            "city": "Newbury",
            "state": "VT",
            "postal_code": "050519712",
            "country_code": "US",
            "telephone_number": "802-866-3000",
            "fax_number": "802-222-5674",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LITTLE RIVERS HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A",
        "authorized_official_last_name": "BARTER",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "802-222-9276"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1012614",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1012615",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradford, VT

Sources for this page

Verify at the official NPI Registry.