Indian Stream Health Center, Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

INDIAN STREAM HEALTH CENTER, INC

Practice address

141 Corliss Lane
Colebrook, NH 03576

Phone

(603) 237-8336

Fax

(603) 237-4467

NPI assigned

Jul 3, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Jonathan W. Brown

Title

Ceo

Phone

(603) 388-2426

Specialties & licenses 2

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 301819

Legal name

INDIAN STREAM HEALTH CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

May 11, 2006

Last certification

May 11, 2006

Ownership / control type

For profit – corporation

Facility address

141 Corliss Lane
Colebrook, NH 03576

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422316800000",
    "number": "1386673952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 CORLISS LANE",
            "city": "COLEBROOK",
            "state": "NH",
            "postal_code": "03576",
            "telephone_number": "603-237-8336",
            "fax_number": "603-237-4467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 CORLISS LANE",
            "city": "COLEBROOK",
            "state": "NH",
            "postal_code": "03576",
            "telephone_number": "603-237-8336",
            "fax_number": "603-237-4467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN STREAM HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2015-01-27",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "603-388-2426",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "NH",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7459647",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8000921",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "200010975",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30213617",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30513983",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "8190651",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF VT",
            "identifier": "00068661",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1011463",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Carmelo Gramuglia, LICSW
• Jill Gregoire, RN, CEN, TCRN, CCRN
• Deborah Ann Hamel, WAIVER
• Sharon Heard-McKnight
• Evelyn Hopkins
• Christine S Johns
• Bruce Jeffrey Katz, DDS
• Richard A Kay, O.D.
• Jennifer Louisa Keazer, RPH
• Renee S Kennett, WAIVERED

• Federally Qualified Health Center (FQHC) in Colebrook, NH
• Providers in Colebrook, NH by specialty
• Federally Qualified Health Center (FQHC) in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.