NPIMap

Organization Active NPI

Gifford Medical Center Inc

  • Critical Access Hospital
  • Randolph, VT
National Provider Identifier
1730199647
Registry record updated Jul 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
GIFFORD MEDICAL CENTER INC
Practice address
44 S Main St
Box 2000
Randolph, VT 05060-1381
Phone
(802) 728-7000
Fax
(802) 728-2613
NPI assigned
Aug 9, 2006
Last updated
Jul 1, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2025

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

Authorized official

Name
Michael K Costa
Title
Ceo
Phone
(802) 728-2211

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X NU Primary

Addresses

Primary practice location

44 S Main St
Box 2000
Randolph, VT 05060-1381

Mailing address

PO Box 2000
44 South Main Street
Randolph, VT 05060-2000
Phone (802) 728-7000

Other identifiers 1

IdentifierTypeStateIssuer
0471301MedicaidVT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121119000002 VT Part A Provider - Critical Access Hospital 4880683663 Receives reassigned benefits from 51 practitioners
Practice locations: White River Junction, VT; Sharon, VT; Rochester, VT; Randolph, VT; Chelsea, VT; Bethel, VT; Barre, VT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730199647. Details of each certification follow.

Hospital certification: CCN 471301

Legal name
GIFFORD MEDICAL CENTER INC
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jun 1, 2001
Last certification
Dec 14, 2023
Beds
52
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jan 9, 1905 in VT
Enrollment address
44 S Main St
Ste 1
Randolph, VT 50601381
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Gifford Medical CenterCCN 471301 · All quality measures
Overall star rating
5 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Gifford Pediatric Inter6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

44 S Main St
#2000
Randolph, VT 05060
Phone (802) 728-7000

44 S Main St
Ste 1
Randolph, VT 05060
Phone (802) 728-2401

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Clay Westbrook Individual Corporate Director Jan 28, 2016
Jody Davignon Individual Corporate Director Jul 24, 2014
Michael K Costa Individual Corporate DirectorChief Executive Officer Oct 3, 2024
W-2 Managing EmployeeChief Executive Officer Oct 3, 2024
Cheyenne Holland Individual Corporate OfficerChief Financial Officer Aug 19, 2024
Theron a Manning Individual Corporate Director May 25, 2017
Todd Winslow Individual Corporate Director Jan 22, 2015
Peter Reed Individual Corporate Director Jan 28, 2016
Matthew Considine Individual Corporate Director Jan 23, 2014

Practitioners & affiliated clinicians

Practitioners 61

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 61

Affiliated clinicians 181

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 181

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751328000000",
    "number": "1730199647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2000",
            "address_2": "44 SOUTH MAIN STREET",
            "city": "RANDOLPH",
            "state": "VT",
            "postal_code": "050602000",
            "telephone_number": "802-728-7000",
            "fax_number": "802-728-2613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 S MAIN ST",
            "address_2": "BOX 2000",
            "city": "RANDOLPH",
            "state": "VT",
            "postal_code": "050601381",
            "telephone_number": "802-728-7000",
            "fax_number": "802-728-2613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIFFORD MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2025-07-01",
        "certification_date": "2025-07-01",
        "status": "A",
        "authorized_official_last_name": "COSTA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "802-728-2211"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0471301",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Randolph, VT

Sources for this page

Verify at the official NPI Registry.