North Country Healthcare, Inc.
Organization Active NPI Pediatrics Physician · Flagstaff, AZ
NPI 1669911764 · NPPES record last updated Jun 30, 2021
Key facts
- NPI
- 1669911764
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- NORTH COUNTRY HEALTHCARE, INC.
- Practice address
- 1501 S Yale St
Ste 252
Flagstaff, AZ 86001-7304 - Phone
- (928) 774-1811
- Fax
- (928) 774-2001
- NPI assigned
- Feb 22, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- NORTH COUNTRY HEALTHCARE, INC.
Authorized official
- Name
- Anne Newland, MD
- Title
- Ceo
- Phone
- (928) 522-9400
Owners & managing parties with NPI records 3
-
Travis Jones, MD
-
Anne M Newland, MD
-
Terri Diane Sherman, APRN-FNP-C
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 2
Practitioners 95
-
Sarah M Coles, M.D.
-
Trasi Lynn Crumrin, D.O.
-
Casey Deleonguerrero, D.O.
-
Tasha Harder, DO
-
Martha McGuffin, NP
-
Ashley Overall, CNP
-
Shari Pressley, MD
-
Shanna Mae Ramat, ARNP
-
Cooper C Schraudenbach, M.D.
-
Jonathan Joseph Tansill, PA-C
-
Madeline Rose Wetterhahn, MD MPH
-
Sungnam Joe, M.D.
-
Susan Michelle Englebert, DNP, WHNP-BC, CNM
-
Sean L'Huillier Sr., FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Federally qualified health center certification: CCN 031953
- Legal name
- NORTH COUNTRY HEALTHCARE INC
- Doing business as
- FLAGSTAFF PEDIATRIC CARE
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Aug 1, 2017
- Last certification
- Aug 1, 2017
- Ownership / control type
- Non-profit – church related
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 17, 1991 in AZ
- Enrollment address
- 1501 S Yale St
Ste 252
Flagstaff, AZ 86001-7336
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Walter Phelps |
Corporate Director |
Jan 1, 2021 | |
| Stephen Nuno Perez |
Corporate Director |
Sep 28, 2021 | |
| Paul Ferris |
Corporate Director |
Jan 1, 2012 | |
| Mike Oxtoby |
Corporate Director |
Sep 28, 2021 | |
| Sandra L Ernst |
Corporate Director |
Sep 28, 2021 | |
| Teri Diane Sherman |
Corporate Director |
Jan 1, 2021 | |
| Patsy Crofford |
Corporate Director |
Jun 1, 2017 | |
| Joshua Butler |
Corporate Director |
Mar 22, 2022 | |
| Anne M Newland |
Corporate Officer |
Nov 2, 2015 | |
| W-2 Managing Employee |
Nov 1, 2015 | ||
| Travis L Jones |
Corporate Director |
Apr 1, 2019 | |
| Mary Jo Gregory |
Corporate Director |
Mar 27, 2018 | |
| Timothy Dodt |
Corporate Director |
May 1, 2018 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Northcountry Healthcare Inc |
Federally qualified health center | Operational/Managerial Control | Nov 30, 2010 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170803002838 | AZ | Part a Provider - Federally Qualified Health Center (FQHC) | 8820981053 | Practice locations: Flagstaff, AZ |
National Provider Directory
- Part of
- North Country Community
Locations
1501 S Yale St
Flagstaff, AZ 86001
Phone (928) 527-4325
2650 E Show Low Lake Rd
Ste 1
Show Low, AZ 85901
Phone (928) 537-4300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes | ||
| Federally Qualified Health Center (FQHC) | 261QF0400X |
Addresses
Primary practice location
1501 S Yale St
Ste 252
Flagstaff, AZ 86001-7304
Mailing address
PO Box 3630
Flagstaff, AZ 86003-3630
Phone (928) 522-9400
Other names
- Flagstaff Pediatric Care
Other providers in Flagstaff, AZ
- North Country Healthcare Inc
- North Country Healthcare-Ponderosa HS
- North Country Healthcare, Inc.
- North Country Healthcare, Inc.
- North Country Healthcare, Inc.
- North Country Healthcare, Inc.
- North Mountain Home Care
- Northern Arizona Affiliated Cardiac Services, LTD
- Northern Arizona Cardiovascular Specialists PC
- Northern Arizona Dermatology Center PC
All providers in Flagstaff, AZ · Pediatrics Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.