NPIMap

Organization Active NPI

Speare Memorial Hospital

Doing business as Plymouth Pediatric and Adolescent Medicine

  • Rural Health Clinic/Center
  • Plymouth, NH
National Provider Identifier
1326587635
Registry record updated Sep 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
01300 Issued in NH
Legal business name
SPEARE MEMORIAL HOSPITAL
Doing business as
Plymouth Pediatric and Adolescent Medicine
Practice address
71 Highland St
Plymouth, NH 03264-1233
Phone
(603) 536-3700
Fax
(603) 536-5384
NPI assigned
Feb 20, 2017
Last updated
Sep 27, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2017

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

Authorized official

Name
Michelle L. McEwen
Title
President / Ceo
Phone
(603) 536-1120

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 01300 NH Primary

Addresses

Primary practice location

71 Highland St
Plymouth, NH 03264-1233

Mailing address

16 Hospital Rd
Plymouth, NH 03264-1126
Phone (603) 536-1120

Other names 1

  • Plymouth Pediatric and Adolescent Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040823001172 NH Part B Supplier - Clinic/Group Practice 1153318068 Receives reassigned benefits from 108 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bristol, NH; Meredith, NH; Plymouth, NH
O20170502000233 NH Part A Provider - Rural Health Clinic 1153318068 Practice locations: Plymouth, NH
O20210409001674 NH DME Supplier - Physician - General Practice 1153318068 Practice locations: Plymouth, NH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1326587635. Details of each certification follow.

Rural health clinic certification: CCN 303995

Legal name
SPEARE MEMORIAL HOSPITAL
Doing business as
PLYMOUTH PEDIATRIC AND ADOLESCENT MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 29, 2025
Last certification
Jun 7, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
71 Highland St
Plymouth, NH 03264-1233
Related CCNs
301311

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 6

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
30D0883291Plymouth Pediatric & Adolescent Medicine71 Highland St, Plymouth, NH 03264Certificate of waiverOct 22, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Elizabeth Kleiner Individual Corporate Director Oct 31, 2019
Susan Scrimshaw Individual Corporate Director Oct 21, 2021
John Moulton Individual Corporate DirectorBoard Member Nov 1, 2024
Joseph T Caristi Individual Corporate OfficerCfo Feb 19, 2024
Corporate DirectorCfo Feb 19, 2024
W-2 Managing EmployeeCfo Feb 19, 2024
Operational/Managerial ControlCfo Feb 19, 2024
Margaret Turner Individual Corporate DirectorBoard Member Apr 9, 2017
Patrick B Miller Individual Corporate DirectorBoard Member Apr 9, 2017
Joseph a Ebner Individual Corporate DirectorChief Medical Officer Jan 1, 2008
Kevin I Young Individual Corporate DirectorBoard Member Apr 9, 2017
Walter Johnson Individual Corporate Director Oct 25, 2018
Steven Camerino Individual Corporate Director Oct 23, 2019
Donna Driscoll Individual Corporate DirectorBoard Member Nov 1, 2024
Ken Evans Individual Corporate DirectorBoard Member Nov 1, 2024
Julie Bernier Individual Corporate Director Oct 25, 2018
Michelle L McEwen Individual Corporate OfficerPresident/Ceo Apr 9, 2017 100%
Corporate DirectorPresident/Ceo Apr 9, 2017 100%
W-2 Managing EmployeePresident/Ceo Apr 9, 2017 100%
Operational/Managerial ControlPresident/Ceo Apr 9, 2017 100%
Eric M Shamansky Individual Corporate DirectorMedical Director Sep 11, 2023
W-2 Managing EmployeeMedical Director Sep 11, 2023
Operational/Managerial ControlMedical Director Sep 11, 2023
Dolores C Hopper Individual Corporate Director Oct 27, 2022

Owners & managing parties with NPI records 2

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

Change-of-ownership history 1

DateEventCounterparty
Apr 9, 2017 Change of OwnershipThis provider was the buyer Dartmouth Hitchcock Clinic - PlymouthCCN 303816, NH, NPI 1548210198

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 5

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": "1487548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506470400000",
    "number": "1326587635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 HOSPITAL RD",
            "city": "PLYMOUTH",
            "state": "NH",
            "postal_code": "032641126",
            "telephone_number": "603-536-1120",
            "fax_number": "603-536-4828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 HIGHLAND ST",
            "city": "PLYMOUTH",
            "state": "NH",
            "postal_code": "032641233",
            "telephone_number": "603-536-3700",
            "fax_number": "603-536-5384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPEARE MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-20",
        "last_updated": "2017-09-27",
        "status": "A",
        "authorized_official_last_name": "MCEWEN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT / CEO",
        "authorized_official_telephone_number": "603-536-1120"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NH",
            "license": "01300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Plymouth Pediatric and Adolescent Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plymouth, NH

Sources for this page

Verify at the official NPI Registry.