NPIMap

Organization Active NPI

Northeastern Vermont Regional Hospital, Inc

Doing business as NVRH St. Johnsbury Pediatrics

  • Primary Care Clinic/Center
  • St Johnsbury, VT
National Provider Identifier
1487732301
Registry record updated Feb 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
NORTHEASTERN VERMONT REGIONAL HOSPITAL, INC
Doing business as
NVRH St. Johnsbury Pediatrics
Practice address
97 Sherman Drive
St Johnsbury, VT 05819-9280
Phone
(802) 748-5131
Fax
(802) 748-4237
NPI assigned
Nov 1, 2006
Last updated
Feb 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2020

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

Authorized official

Name
Robert N Hersey
Title
Cfo
Phone
(802) 748-7520

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 673 VT
Primary Care Clinic/Center 261QP2300X Primary
Rural Health Clinic/Center 261QR1300X 673 VT
Rural Health Clinic/Center 261QR1300X

Addresses

Primary practice location

97 Sherman Drive
St Johnsbury, VT 05819-9280

Mailing address

1315 Hospital Drive
PO Box 905
St Johnsbury, VT 05819-9210
Phone (802) 748-8141

Other identifiers 1

IdentifierTypeStateIssuer
3076791MedicaidNH

Other names 1

  • NVRH St. Johnsbury Pediatrics Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070104000286 VT Part A Provider - Rural Health Clinic 3678481405 Practice locations: Saint Johnsbury, VT
O20090615000418 VT Part B Supplier - Clinic/Group Practice 3678481405 Receives reassigned benefits from 15 practitioners
Practice locations: Saint Johnsbury, VT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487732301. Details of each certification follow.

Rural health clinic certification: CCN 473989

Legal name
NORTHEASTERN VERMONT REGIONAL HOSPITAL INC
Doing business as
NVRH ST JOHNSBURY PEDIATRICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 16, 2007
Last certification
Aug 22, 2022
Ownership / control type
Non-profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
97 Sherman Dr
Saint Johnsbury, VT 05819-9280
Related CCNs
471303

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

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
47D0091973NVRH St Johnsbury Pediatrics97 Sherman Dr, Saint Johnsbury, VT 05819Certificate of waiverJan 31, 2028

National Provider Directory

National Provider Directory
Tax ID family
NVRH OB GYN13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

97 Sherman Dr
St Johnsbury, VT 05819
Phone (802) 748-3722

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Sara J Simpson Individual Corporate DirectorSecretary of the Board/Trustee Dec 1, 2020
Shawn Patrick Tester Individual Corporate OfficerCeo Nov 26, 2018
Thaddeus R Richardson Individual Corporate DirectorTrustee Dec 1, 2019
Susan L Carr Individual Corporate DirectorPresident of the Auxiliary Dec 1, 2023
Joseph S Kasprzak Individual Corporate DirectorTreasurer of the Board/Trustee Dec 1, 2016
Daniel D Daley Individual Corporate DirectorTrustee Dec 1, 2023
Cynthia S Stuart Individual Corporate DirectorTrustee Dec 1, 2023
Steve Arthur Feltus Individual Corporate Officer Dec 1, 2016
Steven McConnell Individual Corporate Director Dec 1, 2017
Jennifer K Harris Individual Corporate DirectorTrustee Dec 1, 2024
Warren C Dow Individual Corporate DirectorVice Chair of the Board/Trustee Dec 1, 2020
Roena D Whitehill Individual Corporate DirectorTrustee Dec 1, 2024
Henry S Parker Individual Corporate DirectorTrustee Dec 1, 2023
Mark S Bowen Individual Corporate DirectorTrustee Dec 1, 2021
Natalie B Morris Individual Corporate DirectorTrustee Dec 1, 2022
Robert J Grant Individual Corporate OfficerVice President of the Medical Staff Jan 1, 2025
Peter F Crosby Individual Corporate DirectorTrustee Dec 1, 2021
Deborah a Harrigan Individual Corporate DirectorPresident of the Medical Staff Jan 1, 2025
John S Kascenska Individual Corporate DirectorChair of the Board/Trustee Dec 1, 2019
Kinsley Sicard Individual Corporate DirectorTrustee Sep 1, 2023
Andre Bissonnette Individual Corporate OfficerChief Financial Officer Jul 15, 2022
W-2 Managing EmployeeChief Financial Officer Jul 15, 2022

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581379200000",
    "number": "1487732301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 HOSPITAL DRIVE",
            "address_2": "PO BOX 905",
            "city": "ST JOHNSBURY",
            "state": "VT",
            "postal_code": "058199210",
            "telephone_number": "802-748-8141",
            "fax_number": "802-748-4098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "97 SHERMAN DRIVE",
            "city": "ST JOHNSBURY",
            "state": "VT",
            "postal_code": "058199280",
            "telephone_number": "802-748-5131",
            "fax_number": "802-748-4237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEASTERN VERMONT REGIONAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-02-11",
        "certification_date": "2020-02-11",
        "status": "A",
        "authorized_official_last_name": "HERSEY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "802-748-7520"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "VT",
            "license": "673",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "VT",
            "license": "673",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3076791",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NVRH St. Johnsbury Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NVRH St. Johnsbury Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Johnsbury, VT

Sources for this page

Verify at the official NPI Registry.