NPIMap

Organization Active NPI

Little Rivers Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Thetford, VT
National Provider Identifier
1659030187
Registry record updated May 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LITTLE RIVERS HEALTH CARE, INC.
Practice address
2689 VT 113
Thetford, VT 05047
Phone
(802) 222-3026
Fax
(802) 222-5654
NPI assigned
Dec 13, 2021
Last updated
May 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2023

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

Authorized official

Name
Andrew Barter
Title
Ceo
Phone
(802) 222-4637

Specialties & licenses 1

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

Addresses

Primary practice location

2689 VT 113
Thetford, VT 05047

Mailing address

PO Box 8
Newbury, VT 05051-0008
Phone (802) 222-3026

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220211001317 VT Part A Provider - Federally Qualified Health Center (FQHC) 8224031497 Practice locations: Thetford, VT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659030187. Details of each certification follow.

Federally qualified health center certification: CCN 471877

Legal name
LITTLE RIVERS HEALTH CARE, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 25, 2022
Last certification
Jan 25, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 12, 2003 in VT
Enrollment address
2689 VT 113
Thetford, VT 50479040

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
Little Rivers Health Care12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Carole C Freeman Individual Corporate DirectorBoard Member Jan 1, 2022
Margaret Burmeister Individual Corporate DirectorBoard Member Jan 1, 2022
Matthew Knisley Individual Corporate DirectorBoard Member Jan 1, 2022
Andrew I Barter Individual Corporate OfficerCeo Aug 15, 2022
W-2 Managing EmployeeCeo Aug 15, 2022
Operational/Managerial ControlCeo Aug 15, 2022
Jill Skochdopole Individual Corporate DirectorBoard Member Jan 1, 2022
Pamela Smith Individual Corporate DirectorBoard Member Jan 1, 2022
Darren Sherburne Individual Corporate DirectorBoard Member Jan 1, 2022
Scott Labun Individual Corporate DirectorBoard Member Jan 1, 2022
William a Campbell Individual Corporate DirectorBoard Member Jan 1, 2022
Kelsey Root-Winchester Individual Corporate DirectorBoard Member Jan 1, 2022

NPI Registry JSON

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

{
    "created_epoch": "1639353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684886400000",
    "number": "1659030187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8",
            "city": "NEWBURY",
            "state": "VT",
            "postal_code": "050510008",
            "telephone_number": "802-222-3026",
            "fax_number": "802-222-5654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2689 VT 113",
            "city": "THETFORD",
            "state": "VT",
            "postal_code": "05047",
            "telephone_number": "802-222-3026",
            "fax_number": "802-222-5654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE RIVERS HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-13",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A",
        "authorized_official_last_name": "BARTER",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "802-222-4637"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thetford, VT

Sources for this page

Verify at the official NPI Registry.