NPIMap

Organization Active NPI

Springfield Medical Care Systems Inc

  • Federally Qualified Health Center (FQHC)
  • Londonderry, VT
National Provider Identifier
1639544331
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SPRINGFIELD MEDICAL CARE SYSTEMS INC
Practice address
38 Vermont Route 11
Londonderry, VT 05148-9555
Phone
(802) 824-6901
NPI assigned
Dec 7, 2015
Last updated
Oct 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Authorized official

Name
Andrew Majka
Title
Cfo
Phone
(802) 886-8950

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

38 Vermont Route 11
Londonderry, VT 05148-9555

Mailing address

PO Box 710
Springfield, VT 05156-0710
Phone (802) 886-8950

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160122001936 VT Part A Provider - Federally Qualified Health Center (FQHC) 9133157043 Practice locations: Londonderry, VT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639544331. Details of each certification follow.

Federally qualified health center certification: CCN 471859

Legal name
SPRINGFIELD MEDICAL CARE SYSTEMS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 24, 2016
Last certification
Feb 24, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 12, 1982 in VT
Enrollment address
38 Vermont Route 11
Londonderry, VT 51489555

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Springfield Medical Care Systems Inc17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Stephen J Varone Individual Corporate DirectorBoard Member Jan 1, 2023 100%
Cheryl a Sanctuary Individual Corporate DirectorBoard Member Jan 1, 2023 100%
Susan P White Individual Corporate DirectorBoard Member Oct 26, 2021 100%
Andrew J Majka Individual Corporate OfficerCfo Jan 1, 2023 100%
Kendra E Ingalls Individual Corporate Director Feb 8, 2019 100%
W-2 Managing Employee Feb 8, 2019 100%
Joshua R Dufresne Individual Corporate OfficerCeo Dec 1, 2018 100%
W-2 Managing EmployeeCeo Dec 1, 2018 100%
Jennifer L Anderson Individual Corporate DirectorBoard Member Oct 26, 2021 100%
Anthony P Petrillo Individual Corporate DirectorBoard Member Dec 8, 2020 100%
Amanda M McLeod Individual Corporate DirectorBoard Member Oct 26, 2021 100%
Edmond H Moore Individual Corporate DirectorBoard Member Dec 28, 2020 100%
Kelly M Pajala Individual Corporate DirectorBoard Member Jan 1, 2023 100%

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Springfield Hospital Inc.Springfield, VT, CCN 471306 Hospital 5% Or Greater Indirect Ownership Interest (100%) May 12, 1982
Springfield Hospital Inc.Springfield, VT, CCN 47Z306 Hospital 5% Or Greater Indirect Ownership Interest (100%) May 12, 1982

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1449446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1639544331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 710",
            "city": "SPRINGFIELD",
            "state": "VT",
            "postal_code": "051560710",
            "telephone_number": "802-886-8950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 VERMONT ROUTE 11",
            "city": "LONDONDERRY",
            "state": "VT",
            "postal_code": "051489555",
            "telephone_number": "802-824-6901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRINGFIELD MEDICAL CARE SYSTEMS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-07",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-24",
        "status": "A",
        "authorized_official_last_name": "MAJKA",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "802-886-8950"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Londonderry, VT

Sources for this page

Verify at the official NPI Registry.