NPIMap

Organization Active NPI

Thundermist Health Center

  • Federally Qualified Health Center (FQHC)
  • Wakefield, RI
National Provider Identifier
1700041001
Registry record updated Jul 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
ACF01566 Issued in RI
Legal business name
THUNDERMIST HEALTH CENTER
Practice address
1 River St
Wakefield, RI 02879-3214
Phone
(401) 783-0523
Fax
(401) 783-9448
NPI assigned
Jul 25, 2008
Last updated
Jul 10, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2026

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

Authorized official

Name
Ckarla Agudelo
Title
Director of Credentialing
Phone
(401) 767-4100

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X
Community/Behavioral Health Agency 251S00000X ACF01566 RI
Federally Qualified Health Center (FQHC) 261QF0400X ACF01566 RI Primary

Addresses

Primary practice location

1 River St
Wakefield, RI 02879-3214

Mailing address

25 John a Cummings Way Ste 203
Woonsocket, RI 02895-3244
Phone (401) 767-4100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030915000009 RI Part A Provider - Federally Qualified Health Center (FQHC) 1557270477 Practice locations: Wakefield, RI
O20040211000909 RI Part B Supplier - Clinic/Group Practice 1557270477 Receives reassigned benefits from 287 practitioners
4 other NPIs on this enrollment
Practice locations: Narragansett, RI; Wakefield, RI; West Warwick, RI; Woonsocket, RI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700041001. Details of each certification follow.

Federally qualified health center certification: CCN 411804

Legal name
THUNDERMIST HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 22, 1992
Last certification
Oct 22, 1992
Ownership / control type
For profit – partnership
Most recent change of ownership
Jul 18, 2002 (1 total)
Organization structure
CorporationNon-profit
Incorporated
May 16, 1974 in RI
Enrollment address
One River Street
Wakefield, RI 28793214

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Thundermist Health Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

450 Clinton St
Woonsocket, RI 02895

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Mary E Fain Individual Corporate DirectorBoard Member Nov 23, 2010
Jon-Paul Capece Individual Corporate DirectorBoard Member Dec 1, 2014
Lawrence P Trim Individual Corporate DirectorBoard Member Nov 23, 2010
Ckarla Agudelo Individual W-2 Managing EmployeeAd;Director of Credentaling Aug 12, 2024
Mary E Caniglia Individual Corporate DirectorBoard Member Dec 1, 2014
Timothy Michael Henry Individual Corporate DirectorVice Chairperson-Board of Direct Nov 23, 2010
Cheryl King Individual Corporate DirectorBoard Member Dec 1, 2014
Donald Larsen Individual Corporate DirectorBoard Member Nov 23, 2010
Linda M Cannistra Individual Corporate DirectorSecretary-Board of Directors Sep 15, 2003
Maureen Mayer Individual Corporate DirectorBoard Member Dec 1, 2014
Michael Douglas Fay Individual Corporate DirectorTreasurer-Board of Directors Sep 15, 2003
Laura Adams Individual Corporate DirectorBoard Member Nov 23, 2010
David Valois Individual Corporate DirectorBoard Member Nov 23, 2010
Lois a Monteiro Individual Corporate DirectorChairperson-Board of Directors Sep 15, 2003
Jeanne M Lachance Individual W-2 Managing EmployeeSenior VP/Chief Admin Officer Dec 1, 2014
Brenda L Seagrave Whittle Individual Corporate DirectorBoard Member Nov 23, 2010

Practitioners & affiliated clinicians

Practitioners 298

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 298

NPI Registry JSON

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

{
    "created_epoch": "1216944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783641600000",
    "number": "1700041001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 JOHN A CUMMINGS WAY STE 203",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028953244",
            "telephone_number": "401-767-4100",
            "fax_number": "401-235-6833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 RIVER ST",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028793214",
            "telephone_number": "401-783-0523",
            "fax_number": "401-783-9448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THUNDERMIST HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-25",
        "last_updated": "2026-07-10",
        "certification_date": "2026-07-10",
        "status": "A",
        "authorized_official_last_name": "AGUDELO",
        "authorized_official_first_name": "CKARLA",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "401-767-4100"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "RI",
            "license": "ACF01566",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "RI",
            "license": "ACF01566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wakefield, RI

Sources for this page

Verify at the official NPI Registry.