NPIMap

Organization Active NPI

North Country Hospital & Health Center Inc

Doing business as North Country Primary Care Newport

  • Internal Medicine Physician
  • Newport, VT
National Provider Identifier
1417023904
Registry record updated Sep 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
NORTH COUNTRY HOSPITAL & HEALTH CENTER INC
Doing business as
North Country Primary Care Newport
Practice address
186 Medical Village Dr
Newport, VT 05855-8537
Phone
(802) 334-3520
Fax
(802) 334-3281
NPI assigned
Nov 27, 2006
Last updated
Sep 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2023

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

Authorized official

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
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 names 1

  • North Country Primary Care Newport Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT2 enrollments

Enrollment records 2

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417023904. Details of each certification follow.

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
CorporationNon-profit
Enrollment address
186 Medical Village Dr
Newport, VT 05855-8932
Related CCNs
471304

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

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory

Locations

186 Medical Village Dr
#1
Newport, VT 05855
Phone (802) 334-3262

Ownership & related parties

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 DirectorBoard-Finance Chair & Treasurer Jan 1, 2024
Louise Bonvechio Individual Corporate DirectorBoard-Chair Jan 1, 2022
Nancy Bullock Individual Corporate OfficerBoard-Secretary/Clerk Jan 1, 2022
Tracey Paul Individual Corporate OfficerCoo Jan 20, 2022
Anita Flagg Individual Corporate OfficerCfo Nov 1, 2025
W-2 Managing EmployeeAd; Nov 1, 2025
Steven Wright Individual Corporate DirectorBoard Member Mar 1, 2018 5%
Deborah L Brown Individual W-2 Managing EmployeeEnrollment Specialist Dec 31, 2018

Practitioners & affiliated clinicians

Practitioners 63

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 63

NPI Registry JSON

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

{
    "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": [],
    "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

Sources for this page

Verify at the official NPI Registry.