NPIMap

Organization Active NPI

Northern Counties Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • St Johnsbury, VT
National Provider Identifier
1639783095
Registry record updated Nov 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHERN COUNTIES HEALTH CARE, INC.
Practice address
1 Eastern Ave
St Johnsbury, VT 05819-2661
Phone
(802) 748-9405
NPI assigned
Sep 3, 2020
Last updated
Nov 10, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHERN COUNTIES HEALTH CARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 10, 2020

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

Authorized official

Name
Meghan Elliott
Title
Human Resources Assistant
Phone
(802) 748-9405

Specialties & licenses 1

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

Addresses

Primary practice location

1 Eastern Ave
St Johnsbury, VT 05819-2661

Mailing address

165 Sherman Dr
St Johnsbury, VT 05819-9811
Phone (802) 748-9405

Other identifiers 1

IdentifierTypeStateIssuer
1009361MedicaidVT

Other names 1

  • Northern Express Care St. Johnsbury Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201102000284 VT Part A Provider - Federally Qualified Health Center (FQHC) 2860300936 1 other NPI on this enrollment
Practice locations: St Johnsbury, VT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639783095. Details of each certification follow.

Federally qualified health center certification: CCN 471871

Legal name
NORTHERN COUNTIES HEALTH CARE INC
Doing business as
NORTHERN EXPRESS CARE ST. JOHNSBURY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 2, 2020
Last certification
Nov 2, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 23, 1976 in VT
Enrollment address
457 Railroad St
Ste 2
St Johnsbury, VT 58191643

Other NPIs with the same Medicare PAC ID 9

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
Part of
Northern Counties Healt

Locations

1 Eastern Ave
St Johnsbury, VT 05819
Phone (802) 748-9405

165 Sherman Dr
St Johnsbury, VT 05819
Phone (802) 748-9405

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Angela Neil Individual Corporate OfficerChief Financial Officer May 1, 2021
Nancy Reynolds Individual Corporate Director May 23, 2018
Michael K Costa Individual Corporate OfficerCeo Mar 19, 2019
W-2 Managing EmployeeCeo Mar 19, 2019
Karena Shippee Individual Corporate Director Oct 10, 2019
Cynthia S Stuart Individual Corporate Director Jan 24, 2018
Caroline Frey Individual Corporate Director Oct 19, 2017
Alan Cronauer Individual Corporate Director Aug 23, 2017
Laura Newell Individual Corporate Director Apr 24, 2019
Jennifer Guss Individual Corporate Director Apr 24, 2019
Raymond Small Individual Corporate Director Nov 21, 2018
Ronald Steen Individual Corporate Director Oct 10, 2019
Ellen CF Moore Individual Corporate Director Oct 24, 2018
Ann Creaven Individual Corporate Director Sep 26, 2018
Katherine Gent Individual Corporate Director Oct 10, 2019

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 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1599091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604966400000",
    "number": "1639783095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 SHERMAN DR",
            "city": "ST JOHNSBURY",
            "state": "VT",
            "postal_code": "058199811",
            "telephone_number": "802-748-9405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 EASTERN AVE",
            "city": "ST JOHNSBURY",
            "state": "VT",
            "postal_code": "058192661",
            "telephone_number": "802-748-9405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN COUNTIES HEALTH CARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHERN COUNTIES HEALTH CARE, INC.",
        "enumeration_date": "2020-09-03",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "MEGHAN",
        "authorized_official_title_or_position": "HUMAN RESOURCES ASSISTANT",
        "authorized_official_telephone_number": "802-748-9405"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1009361",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Express Care St. Johnsbury",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in St Johnsbury, VT

Sources for this page

Verify at the official NPI Registry.