NPIMap

Organization Active NPI

Nantucket Cottage Hospital

  • Rural Health Clinic/Center
  • Nantucket, MA
National Provider Identifier
1477021608
Registry record updated Jun 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
NANTUCKET COTTAGE HOSPITAL
Practice address
57 Prospect St
Nantucket, MA 02554-2799
Phone
(508) 825-8100
NPI assigned
Nov 6, 2018
Organization subpart
Yes
Parent organization
NANTUCKET COTTAGE HOSPITALAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Ms. Nancy Sue Pittman
Title
Director of Contracting/Compliance
Phone
(508) 825-8203

Owners & managing parties with NPI records 7

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

Other NPIs on the same Medicare enrollment 1

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

Other NPIs with the same Medicare PAC ID 3

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

Corporate family (same tax ID) 2

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

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

Facilities with the same owner 15

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 250

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

View all 250

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA2 enrollments

Rural health clinic certification: CCN 223979

Medicare enrollment files
Legal name
NANTUCKET COTTAGE HOSPITAL
Doing business as
NANTUCKET COTTAGE MEDICAL GROUP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 16, 2019
Last certification
Jul 16, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
57 Prospect St
Nantucket, MA 02554-2799
Related CCNs
220177

All disclosed owners & managing parties 25

Medicare enrollment files

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

NameRoleSinceShare
Derek a Andelloux Individual Corporate DirectorTrustee - Medical Staff President Sep 13, 2023
Jeanine M Borthwick Individual Corporate DirectorTrustee, Vice Chair Aug 24, 2022
Melissa D Philbrick Individual Corporate DirectorTrustee Aug 16, 2019
Hillary Reynolds Individual Corporate OfficerAssistant Clerk Aug 21, 2020
Nantucket Cottage Hospital Organization, Nantucket, MA Corporation, Non-profit Operational/Managerial Control Jul 16, 2019 100%
Timothy R Mullen Individual Corporate DirectorTrustee Aug 24, 2022
Craig H Muhlhauser Individual Corporate DirectorTrustee Aug 16, 2019
Elizabeth B Wright Individual Corporate DirectorTrustee Aug 24, 2022
Jeffrey M Drazen Individual Corporate DirectorTrustee Aug 16, 2019
Ronald Levy Individual Corporate DirectorTrustee Aug 21, 2020
Joanna Hazell Individual Corporate DirectorDirector Mar 16, 2021
Charles K Gifford Individual Corporate DirectorTrustee Apr 19, 2013
Elizabeth Tilney Individual Corporate DirectorTrustee Jan 1, 2024
Matthew Hutter Individual Corporate DirectorTrustee Jan 19, 2024
Gerard Joseph Keneally Individual Corporate DirectorTrustee, Vice Chair Jul 21, 2023
Douglass E Karp Individual Corporate DirectorTrustee Jun 1, 2024
David O Volpi Individual Corporate DirectorTrustee Aug 16, 2019
Nancy S Pittman Individual Corporate OfficerClerk Aug 21, 2020
W-2 Managing Employee Jan 5, 2016
Michelle C Atchinson Individual Corporate DirectorTrustee Mar 21, 2025
Vincent T McDermott Individual Corporate OfficerOfficer / Treasurer Mar 24, 2023
Anne Klibanski Individual Corporate Director May 1, 2019
Mass General Brigham Incorporated Organization, Somerville, MA Corporation, Non-profit Operational/Managerial Control Jun 1, 2019
Amy Lee Individual Corporate OfficerPresident Oct 17, 2022
Heather Mahoney O'Sullivan Individual Corporate DirectorTrustee Mar 3, 2023
Jeannette Ives Erickson Individual Corporate DirectorTrustee Oct 17, 2022

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20050104000928 MA Part B Supplier - Clinic/Group Practice 1759357601 Receives reassigned benefits from 243 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Nantucket, MA
O20190301001989 MA Part a Provider - Rural Health Clinic 1759357601 Practice locations: Nantucket, MA

National Provider Directory

National Provider Directory
Tax ID family
Nantucket Cottage (3 organizations share this tax ID)
Part of
Nantucket Cottage

Locations

6 Bayberry Ct
Nantucket, MA 02554
Phone (508) 825-8191

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

NPPES NPI Registry

Primary practice location

57 Prospect St
Nantucket, MA 02554-2799

Mailing address

57 Prospect St
Nantucket, MA 02554-2799
Phone (508) 825-8100

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
110026734DMedicaidMA

Other names 1

NPPES NPI Registry
  • Nantucket Cottage Medical Group Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 1, 2020.

{
    "created_epoch": "1541462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590969600000",
    "number": "1477021608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 PROSPECT ST",
            "city": "NANTUCKET",
            "state": "MA",
            "postal_code": "025542799",
            "telephone_number": "508-825-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 PROSPECT ST",
            "city": "NANTUCKET",
            "state": "MA",
            "postal_code": "025542799",
            "telephone_number": "508-825-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NANTUCKET COTTAGE HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NANTUCKET COTTAGE HOSPITAL",
        "enumeration_date": "2018-11-06",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A",
        "authorized_official_last_name": "PITTMAN",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "DIRECTOR OF CONTRACTING/COMPLIANCE",
        "authorized_official_telephone_number": "508-825-8203",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110026734D",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nantucket Cottage Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Nantucket Cottage Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nantucket, MA

Sources for this page

Verify at the official NPI Registry.