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North Country Hospital & Health Center Inc

Organization Active NPI Internal Medicine Physician · Newport, VT

NPI 1417023904 · NPPES record last updated Sep 12, 2023

Key facts

NPI
1417023904
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
NORTH COUNTRY HOSPITAL & HEALTH CENTER INC
Practice address
186 Medical Village Dr
Newport, VT 05855-8537
Phone
(802) 334-3520
Fax
(802) 334-3281
NPI assigned
Nov 27, 2006
Organization subpart
No

Authorized official

Name
Deborah L Brown
Title
Enrollment Specialist
Phone
(802) 334-3210

Other NPIs with the same Medicare PAC ID 7

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

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

Practitioners 77

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 77

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in VT

Rural health clinic certification: CCN 473979

Legal name
NORTH COUNTRY HOSPITAL & HEALTH CENTER INC
Doing business as
NORTH COUNTRY PRIMARY CARE NEWPORT
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 30, 1994
Last certification
Oct 16, 2023
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Enrollment address
186 Medical Village Dr
Newport, VT 05855-8932
Related CCNs
471304

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Ellen Stanley
Individual 		Corporate Director
Board-Finance Chair & Treasurer		 Jan 1, 2024
Louise Bonvechio
Individual 		Corporate Director
Board-Chair		 Jan 1, 2022
Nancy Bullock
Individual 		Corporate Officer
Board-Secretary/Clerk		 Jan 1, 2022
Tracey Paul
Individual 		Corporate Officer
Coo		 Jan 20, 2022
Anita Flagg
Individual 		Corporate Officer
Cfo		 Nov 1, 2025
W-2 Managing Employee
Ad;		 Nov 1, 2025
Steven Wright
Individual 		Corporate Director
Board Member		 Mar 1, 2018 5%
Deborah L Brown
Individual 		W-2 Managing Employee
Enrollment Specialist		 Dec 31, 2018

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20060127000116 VT Part B Supplier - Clinic/Group Practice 9739073479 Receives reassigned benefits from 49 practitioners
Practice locations: Newport, VT
O20070720000498 VT Part a Provider - Rural Health Clinic 9739073479 Practice locations: Newport, VT

National Provider Directory

Locations

41 Medical Village Dr
Newport, VT 05855
Phone (802) 334-3500

186 Medical Village Dr
#2
Newport, VT 05855
Phone (802) 334-3520

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X Yes
Rural Health Clinic/Center 261QR1300X
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

186 Medical Village Dr
Newport, VT 05855-8537

Mailing address

186 Medical Village Dr
Newport, VT 05855-8537
Phone (802) 334-3522

Other identifiers

IdentifierTypeStateIssuer
0473979MedicaidVT
0VN0873MedicaidVT
NORT00019718OtherVTBLUE CROSS BLUE SHIELD
CN1521OtherVTRAILROAD MEDICARE
8000696OtherVTLADIES FIRST

Other names

  • North Country Primary Care Newport Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 12, 2023.

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694476800000",
    "number": "1417023904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "186 MEDICAL VILLAGE DR",
            "city": "NEWPORT",
            "state": "VT",
            "postal_code": "058558537",
            "telephone_number": "802-334-3522",
            "fax_number": "802-334-3512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "186 MEDICAL VILLAGE DR",
            "city": "NEWPORT",
            "state": "VT",
            "postal_code": "058558537",
            "telephone_number": "802-334-3520",
            "fax_number": "802-334-3281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH COUNTRY HOSPITAL & HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ENROLLMENT SPECIALIST",
        "authorized_official_telephone_number": "802-334-3210"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0473979",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0VN0873",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "NORT00019718",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CN1521",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LADIES FIRST",
            "identifier": "8000696",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Country Primary Care Newport",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Country Primary Care Newport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newport, VT

All providers in Newport, VT · Internal Medicine Physician in Vermont

Sources for this page

Verify at the official NPI Registry.