NPIMap

Organization Active NPI

Thundermist Health Center

  • Federally Qualified Health Center (FQHC)
  • West Warwick, RI
National Provider Identifier
1376708560
Registry record updated Aug 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
ACF01610 Issued in RI
Legal business name
THUNDERMIST HEALTH CENTER
Practice address
186 Providence St
West Warwick, RI 02893-2508
Phone
(401) 615-2800
Fax
(401) 615-2805
NPI assigned
Jul 28, 2008
Last updated
Aug 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2026

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

Authorized official

Name
Ckarla Agudelo
Title
Director of Credentialing
Phone
(401) 767-4100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X ACF01610 RI
Federally Qualified Health Center (FQHC) 261QF0400X ACF01610 RI Primary

Addresses

Primary practice location

186 Providence St
West Warwick, RI 02893-2508

Mailing address

25 John a Cummings Way Ste 203
Woonsocket, RI 02895-3244
Phone (401) 767-4100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030415000024 RI Part A Provider - Federally Qualified Health Center (FQHC) 1557270477 Practice locations: West Warwick, RI
O20040211000909 RI Part B Supplier - Clinic/Group Practice 1557270477 Receives reassigned benefits from 287 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Narragansett, RI; Wakefield, RI; West Warwick, RI; Woonsocket, RI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376708560. Details of each certification follow.

Federally qualified health center certification: CCN 411815

Legal name
THUNDERMIST HEALTH CENTER
Doing business as
THUNDERMIST HEALTH CENTER OF WEST WARWICK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 20, 2003
Last certification
Nov 20, 2003
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 16, 1974 in RI
Enrollment address
186 Providence St
West Warwick, RI 28932508

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Thundermist Health Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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
Lawrence P Trim Individual Corporate DirectorBoard Member Nov 23, 2010
Ckarla Agudelo Individual W-2 Managing EmployeeAd;Director of Credentialing Nov 17, 2025
Mary E Caniglia Individual Corporate DirectorBoard Member Jan 2, 2016
Timothy Michael Henry Individual Corporate DirectorVice Chairperson - Board of Dire Nov 23, 2010
Erin Cooney Individual Corporate DirectorChairperson Nov 17, 2025
Sara Elizabeth Delaporta Individual Corporate DirectorBoard Member Nov 17, 2025
Mark Knott Individual Corporate DirectorBoard Member Nov 17, 2025
Adozinda F Kane Individual Corporate OfficerCfo Dec 16, 2024
W-2 Managing EmployeeAd; Dec 16, 2024
Linda M Cannistra Individual Corporate DirectorSecretary - Board of Directors Aug 29, 2003
Charles T Jones Individual Corporate OfficerPresident / Ceo Jan 2, 2016
W-2 Managing EmployeePresident / Ceo Jan 2, 2016
Victoria St Germain Individual Corporate DirectorVice Chair Person Nov 17, 2025
Deborah Ruggiero Individual Corporate DirectorBoard Member Nov 17, 2025
Daniel Warner Individual Corporate DirectorBoard Member Nov 17, 2025
David Valois Individual Corporate DirectorBoard Member Nov 23, 2010
Michael Souza Individual Corporate DirectorTreasurer Nov 17, 2025
Ivonne Rodriguez Individual Corporate DirectorBoard Member Nov 17, 2025
Andrea Rollin Individual Corporate DirectorBoard Member Nov 17, 2025
Christopher Koller Individual Corporate DirectorBoard Member Nov 17, 2025
Todd a Conklin Individual Corporate DirectorBoard Member Nov 17, 2025

Practitioners & affiliated clinicians

Practitioners 88

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 88

NPI Registry JSON

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

{
    "created_epoch": "1217203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786579200000",
    "number": "1376708560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 JOHN A CUMMINGS WAY STE 203",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028953244",
            "telephone_number": "401-767-4100",
            "fax_number": "401-235-6833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "186 PROVIDENCE ST",
            "city": "WEST WARWICK",
            "state": "RI",
            "postal_code": "028932508",
            "telephone_number": "401-615-2800",
            "fax_number": "401-615-2805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THUNDERMIST HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-28",
        "last_updated": "2026-08-13",
        "certification_date": "2026-08-13",
        "status": "A",
        "authorized_official_last_name": "AGUDELO",
        "authorized_official_first_name": "CKARLA",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "401-767-4100"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "RI",
            "license": "ACF01610",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "RI",
            "license": "ACF01610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Warwick, RI

Sources for this page

Verify at the official NPI Registry.