NPIMap

Organization Active NPI

Community Health Centers of the Rutland Region, Inc.

Doing business as CHCRR Pediatrics

  • Pediatrics Physician
  • Rutland, VT
National Provider Identifier
1780969345
Registry record updated Jan 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION, INC.
Doing business as
CHCRR Pediatrics
Practice address
1 General Wing Rd
Rutland, VT 05701-4681
Phone
(802) 773-9131
Fax
(802) 773-1551
NPI assigned
Oct 14, 2011
Last updated
Jan 18, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2017

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

Authorized official

Name
Michael Gardner
Title
Finance Director
Phone
(802) 855-2083

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

1 General Wing Rd
Rutland, VT 05701-4681

Mailing address

71 Allen St
Suite 101
Rutland, VT 05701-4570
Phone (800) 468-9118

Other identifiers 3

IdentifierTypeStateIssuer
03891774MedicaidNY
0471842MedicaidVT
1019786MedicaidVT

Other names 1

  • CHCRR Pediatrics Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120223000784 VT Part A Provider - Federally Qualified Health Center (FQHC) 2961467386 Practice locations: Rutland, VT
O20120321000420 VT Part B Supplier - Clinic/Group Practice 2961467386 Receives reassigned benefits from 134 practitioners
Practice locations: Rutland, VT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780969345. Details of each certification follow.

Federally qualified health center certification: CCN 471842

Legal name
COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION INC
Doing business as
CHCRR PEDIATRICS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 29, 2012
Last certification
Feb 29, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 2004 in VT
Enrollment address
1 General Wing Road
Chcrr Pediatrics
Rutland, VT 57014681

Other NPIs with the same Medicare PAC ID 8

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
47D0091805Chcrr Pediatrics1 General Wing Road, Rutland, VT 05701Certificate of waiverJul 16, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Robert Hedden Individual Corporate Director Jan 1, 2025
Joanne Calvi Individual Corporate DirectorBoard Member Mar 1, 2011 6.25%
Robert Riley Individual Corporate DirectorBoard Member Feb 28, 2017
Amy Menard Individual Corporate DirectorBoard Member Jan 14, 2014 6.25%
Charles Becker Individual Corporate Director Jan 1, 2025
Chadd Viger Individual Corporate Director Jan 1, 2025
Michael Gardner Individual Corporate DirectorChief Financial Officer May 1, 2019 6.25%
W-2 Managing EmployeeChief Financial Officer May 1, 2019 6.25%
Matthew Whitcomb Individual Corporate Director Jan 1, 2025
Richard Griffith Individual Corporate Officer Jun 1, 2022
Corporate DirectorBoard Member Jun 1, 2006 6.25%
Nancy Morlino Individual Corporate DirectorBoard Member Jan 22, 2019 6.5%
Lawrence Jensen Individual Corporate DirectorBoard Member Sep 1, 2003 6.25%
Damien Barnes Individual Corporate DirectorBoard Member Jul 1, 2023
Elizabeth Kyhill Individual Corporate DirectorBoard Member Sep 1, 2023
Carol Ballou Individual Corporate DirectorBoard Member Jul 25, 2017
Jade Mead Individual Corporate DirectorBoard Member Nov 1, 2021
Jennifer L Scott Individual Corporate DirectorBoard Member Dec 1, 2023
Luther Brown Individual Corporate DirectorBoard Member Jun 30, 2021
Joseph Kraus Individual Corporate Director Jan 1, 2025

Practitioners & affiliated clinicians

Practitioners 140

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 140

NPI Registry JSON

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

{
    "created_epoch": "1318550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484697600000",
    "number": "1780969345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 ALLEN ST",
            "address_2": "SUITE 101",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014570",
            "telephone_number": "800-468-9118",
            "fax_number": "802-772-7973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GENERAL WING RD",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014681",
            "telephone_number": "802-773-9131",
            "fax_number": "802-773-1551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-14",
        "last_updated": "2017-01-18",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "802-855-2083"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03891774",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0471842",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1019786",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHCRR Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rutland, VT

Sources for this page

Verify at the official NPI Registry.