NPIMap

Organization Active NPI

Wentworth Douglass Hospital

  • Diabetes Educator Registered Nurse
  • Dover, NH
National Provider Identifier
1407385198
Registry record updated Dec 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diabetes Educator Registered NurseTaxonomy code 163WD0400X
Legal business name
WENTWORTH DOUGLASS HOSPITAL
Practice address
15 Old Rollinsford Rd Ste 105
Dover, NH 03820-2870
Phone
(603) 742-5252
NPI assigned
Jun 7, 2017
Last updated
Dec 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2025

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

Authorized official

Name
Joel Degenaars
Title
Executive Director of Finance
Phone
(603) 740-2806

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X NU
Diabetes Educator Registered Nurse 163WD0400X NU Primary

Addresses

Primary practice location

15 Old Rollinsford Rd Ste 105
Dover, NH 03820-2870

Mailing address

PO Box 412540
Boston, MA 02241-2540

Other practice location 1

789 Central Ave
Dover, NH 03820-2526
Phone (603) 742-5252

Other identifiers 2

IdentifierTypeStateIssuer
004786OtherNHADA CERTIFICATION
3074430MedicaidNH

Other names 1

  • Diabetes Services Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040730000120 NH Part B Supplier - Clinic/Group Practice 9234047762 Receives reassigned benefits from 4 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dover, NH; Somersworth, NH; Rochester, NH; Portsmouth, NH; Lee, NH; Durham, NH
O20050502000264 NH Part A Provider - Hospital 9234047762 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portsmouth, NH; Somersworth, NH; Rochester, NH; Durham, NH; Lee, NH; Dover, NH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407385198. Details of each certification follow.

Hospital certification: CCN 300018

Legal name
WENTWORTH DOUGLASS HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jun 1, 1998
Beds
178
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
789 Central Ave
Dover, NH 38202526
Other Hospital Practice Location
Hospital subgroups
Acute care

Other NPIs on the same Medicare enrollment 11

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Wentworth-Douglass HospitalCCN 300018 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Scott J Low DO17 organizations share this tax ID, including this one
Part of
Scott J Low DO

Other organizations with this tax ID 16

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

View all 16

Locations

15 Old Rollinsford Rd
Ste 105
Dover, NH 03820
Phone (603) 740-2647

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
Cynthia P Paciulli Individual Corporate OfficerAssistant Treasurer Aug 5, 2024
Corporate DirectorBoard Member Aug 31, 2022
Ingo Roemer Individual Corporate DirectorBoard of Trustees Jan 1, 2017
Michael S Ferrara Individual Corporate DirectorBoard Member/Trustee Aug 5, 2024
Debbie Dube Reed Individual Corporate DirectorBoard Member - Trustee Aug 31, 2022
Arul Mahadevan Individual Corporate OfficerOfficer / Secretary Aug 5, 2024
Corporate DirectorBoard Member Aug 31, 2022
Joel Degenaars Individual Corporate DirectorVice President of Fiance Jan 2, 2022
Lloyd L Hamm Individual Corporate DirectorBoard Member - Trustee Jul 1, 2025
Thomas Torr Individual Corporate DirectorBoard Member - Trustee Aug 5, 2024
Joanna Hazell Individual Corporate DirectorDirector, Provider Enrollment Jan 1, 2024
Michelle Kurtz Individual Corporate OfficerOfficer / Treasurer Aug 5, 2024
Corporate DirectorBoard Member Aug 31, 2022
Darin Roark Individual Corporate OfficerPresident & Coo Jul 24, 2023
Operational/Managerial Control Jul 24, 2023
Vincent T McDermott Individual Corporate DirectorBoard Member - Trustee Aug 7, 2023
Anne Klibanski Individual Operational/Managerial ControlPresident & Ceo Jan 2, 2024
The General Hospital Corporation Organization, Boston, MA Corporation, Non-profit Other Jan 1, 2017 100%
Anne L Jamieson Individual Corporate DirectorBoard Member - Trustee Jun 19, 2021
John J Novello Individual Corporate OfficerAssistant Secretary Aug 5, 2024
Corporate DirectorBoard Member/Trustee Jan 1, 2017
David Staples Individual Corporate DirectorBoard Member - Trustee Aug 5, 2024
Lukas R Kolm Individual Corporate DirectorBoard Member - Trustee Jan 1, 2023
John Fangman Individual Corporate DirectorBoard Member/Trustee Jul 1, 2025

Owners & managing parties with NPI records 6

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

Practitioners & affiliated clinicians

Affiliated clinicians 1,368

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 1,368

NPI Registry JSON

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

{
    "created_epoch": "1496793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765929600000",
    "number": "1407385198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 412540",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022412540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 OLD ROLLINSFORD RD STE 105",
            "city": "DOVER",
            "state": "NH",
            "postal_code": "038202870",
            "telephone_number": "603-742-5252"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "789 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Dover",
            "state": "NH",
            "postal_code": "038202526",
            "country_code": "US",
            "telephone_number": "603-742-5252",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WENTWORTH DOUGLASS HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-07",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A",
        "authorized_official_last_name": "DEGENAARS",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "603-740-2806"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADA CERTIFICATION",
            "identifier": "004786",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3074430",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diabetes Services",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Diabetes Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Dover, NH

Sources for this page

Verify at the official NPI Registry.