NPIMap

Organization Active NPI

Nantucket Cottage Hospital

Doing business as Nantucket Cottage Medical Group

  • 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
Doing business as
Nantucket Cottage Medical Group
Practice address
57 Prospect St
Nantucket, MA 02554-2799
Phone
(508) 825-8100
NPI assigned
Nov 6, 2018
Last updated
Jun 1, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
NANTUCKET COTTAGE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 1, 2020

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

Authorized official

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

Specialties & licenses 1

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

Addresses

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

IdentifierTypeStateIssuer
110026734DMedicaidMA

Other names 1

  • Nantucket Cottage Medical Group Doing business as

Medicare participation

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

Enrollment records 2

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477021608. Details of each certification follow.

Rural health clinic certification: CCN 223979

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

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Nantucket Cottage3 organizations share this tax ID, including this one
Part of
Nantucket Cottage

Other organizations with this tax ID 2

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

Locations

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

Ownership & related parties

All disclosed owners & managing parties 25

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

Owners & managing parties with NPI records 7

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

Facilities with the same owner 15

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

View all 15

Practitioners & affiliated clinicians

Practitioners 248

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 248

NPI Registry JSON

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

{
    "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.