North Country Healthcare, Inc.

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

NORTH COUNTRY HEALTHCARE, INC.

Practice address

2585 S. Miracle Mile
Ste 116
Bullhead, AZ 86442

Phone

(928) 704-1221

Fax

(928) 704-1243

NPI assigned

Aug 30, 2010

Last updated

Jun 30, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

NORTH COUNTRY HEALTHCARE, INC.As reported in NPPES

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

Authorized official

Name

Anne Newland, MDNPI 1336178912

Title

Ceo

Phone

(928) 522-9400

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760798680. Details of each certification follow.

• CCN 031888 Federally qualified health center · Terminated · Details

Federally qualified health center certification: CCN 031888

Legal name

NORTH COUNTRY HEALTHCARE INC

Doing business as

NORTHCOUNTRY HEALTHCARE INC

Certification status

Terminated Voluntary: merger or closure, Dec 24, 2025

Provider type (POS)

Federally qualified health center

Participating since

Jan 31, 2011

Last certification

Jan 31, 2011

Ownership / control type

Non-profit – church related

Organization structure

CorporationNon-profit

Incorporated

Jul 17, 1991 in AZ

Enrollment address

2585 Miracle Mile
Ste 116
Bullhead City, AZ 86442-7562

Other NPIs with the same Medicare PAC ID 2

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

• North Country Healthcare, Inc.

  • Federally Qualified Health Center (FQHC)
  • Kingman, AZ
  • NPI 1023432424

  8820981053

  Same PAC ID
• North Country Healthcare, Inc.

  dba Flagstaff Pediatric Care

  • Pediatrics Physician
  • Flagstaff, AZ
  • NPI 1669911764

  8820981053

  Same PAC ID

Part of

North Country Community

Locations

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.

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Travis Jones, MD

  • Emergency Medicine Physician
  • Tucson, AZ
  • NPI 1245493766

  Corporate Director

  CMS ownership
• Anne M Newland, MD

  • Internal Medicine Physician
  • Flagstaff, AZ
  • NPI 1336178912

  Corporate Officer, W-2 Managing Employee

  CMS ownership
• North Country Healthcare, Inc.

  • Federally Qualified Health Center (FQHC)
  • Kingman, AZ
  • NPI 1023432424

  Operational/Managerial Control

  CMS ownership
• North Country Healthcare, Inc.

  dba Flagstaff Pediatric Care

  • Pediatrics Physician
  • Flagstaff, AZ
  • NPI 1669911764

  Operational/Managerial Control

  CMS ownership
• Terri Diane Sherman, APRN-FNP-C

  • Family Nurse Practitioner
  • Williams, AZ
  • NPI 1801972880

  Corporate Director

  CMS ownership

Practitioners 7

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.

• Anne M Newland, MD

  • Internal Medicine Physician
  • Flagstaff, AZ
  • NPI 1336178912
  Authorized official Same address or phone
• Nicole Angela Kelly-Gordon

  • Clinical Social Worker
  • Flagstaff, AZ
  • NPI 1851752224
  NPD
• Ashlie Larriva, LPC

  • Professional Counselor
  • Flagstaff, AZ
  • NPI 1922707322
  NPD
• Meredith Grace Merkley, D.O.

  • Pediatrics Physician
  • Flagstaff, AZ
  • NPI 1275950420
  NPD
• Jeffrey G Reres, DO

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1346292950
  NPD
• Miran Joelle Song, MD

  • Pediatrics Physician
  • Flagstaff, AZ
  • NPI 1366415846
  NPD
• Paul T Yoder, MD

  • Family Medicine Physician
  • Payson, AZ
  • NPI 1780779991
  NPD

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

{
    "created_epoch": "1283126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625011200000",
    "number": "1760798680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3630",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860033630",
            "telephone_number": "928-522-9400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2585 S. MIRACLE MILE",
            "address_2": "STE 116",
            "city": "BULLHEAD",
            "state": "AZ",
            "postal_code": "86442",
            "telephone_number": "928-704-1221",
            "fax_number": "928-704-1243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH COUNTRY HEALTHCARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH COUNTRY HEALTHCARE, INC.",
        "enumeration_date": "2010-08-30",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A",
        "authorized_official_last_name": "NEWLAND",
        "authorized_official_first_name": "ANNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "928-522-9400",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "576587",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Henry Sy, PHARMD

• Multi-Specialty Clinic/Center in Bullhead, AZ
• Providers in Bullhead, AZ by specialty
• Multi-Specialty Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.