Community Health Centers of the Rutland Region, Inc.
Organization Active NPI Pediatrics Physician · Rutland, VT
NPI 1780969345 · NPPES record last updated Jan 18, 2017
Key facts
- NPI
- 1780969345
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- Legal business name
- COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION, INC.
- Practice address
- 1 General Wing Rd
Rutland, VT 05701-4681 - Phone
- (802) 773-9131
- Fax
- (802) 773-1551
- NPI assigned
- Oct 14, 2011
- Organization subpart
- No
Authorized official
- Name
- Michael Gardner
- Title
- Finance Director
- Phone
- (802) 855-2083
Other NPIs with the same Medicare PAC ID 8
Practitioners 157
-
Allison Barbara Adams, M.D.
-
Folake Azeez, PMHNP
-
Sally J Beayon, FNP-C
-
Carl E Beckler, MD
-
Jennifer A Broomfield, LCSW
-
Krystal J Brown, LICSW
-
Lisa E Brown, LICSW
-
Samuel Joseph Cahill, PA-C
-
Katherine Cardenas, LCDC
-
Ayla Lewis Carr, FNP-C
-
Jordan David Carr, PA-C
-
Sarah Elizabeth Christiana, DNP, FNP-BC
-
Laurie A Coombs, MSW, LCSW
-
Kayla W Cummings, APRN
-
Lisa S Cushing, P.A.
-
John F Dick II, MD
-
Amanda K Domingus, APRN
-
Kassia Ann Dutton, APRN
-
Sarah Hart Dwyer, APRN
-
Andre Jermaine Eason Jr., LADC, LCMHC
-
Laura G Ethier, LICSW
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 47D0091805 | Chcrr Pediatrics | Certificate of waiver | Jul 16, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VT
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
- Corporation · Non-profit
- Incorporated
- Oct 1, 2004 in VT
- Enrollment address
- 1 General Wing Road
Chcrr Pediatrics
Rutland, VT 57014681
All disclosed owners & managing parties 18
| Name | Role | Since | Share |
|---|---|---|---|
| Robert Hedden |
Corporate Director | Jan 1, 2025 | |
| Joanne Calvi |
Corporate Director |
Mar 1, 2011 | 6.25% |
| Robert Riley |
Corporate Director |
Feb 28, 2017 | |
| Amy Menard |
Corporate Director |
Jan 14, 2014 | 6.25% |
| Charles Becker |
Corporate Director | Jan 1, 2025 | |
| Chadd Viger |
Corporate Director | Jan 1, 2025 | |
| Michael Gardner |
Corporate Director |
May 1, 2019 | 6.25% |
| W-2 Managing Employee |
May 1, 2019 | 6.25% | |
| Matthew Whitcomb |
Corporate Director | Jan 1, 2025 | |
| Richard Griffith |
Corporate Officer | Jun 1, 2022 | |
| Corporate Director |
Jun 1, 2006 | 6.25% | |
| Nancy Morlino |
Corporate Director |
Jan 22, 2019 | 6.5% |
| Lawrence Jensen |
Corporate Director |
Sep 1, 2003 | 6.25% |
| Damien Barnes |
Corporate Director |
Jul 1, 2023 | |
| Elizabeth Kyhill |
Corporate Director |
Sep 1, 2023 | |
| Carol Ballou |
Corporate Director |
Jul 25, 2017 | |
| Jade Mead |
Corporate Director |
Nov 1, 2021 | |
| Jennifer L Scott |
Corporate Director |
Dec 1, 2023 | |
| Luther Brown |
Corporate Director |
Jun 30, 2021 | |
| Joseph Kraus |
Corporate Director | Jan 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
1 General Wing Rd
Rutland, VT 05701
Phone (802) 773-9131
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | Yes | ||
| Federally Qualified Health Center (FQHC) | 261QF0400X |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03891774 | Medicaid | NY | |
| 1019786 | Medicaid | VT | |
| 0471842 | Medicaid | VT |
Other names
- CHCRR Pediatrics
Other providers in Rutland, VT
- Community Health Centers of the Rutland Region Inc
- Community Health Centers of the Rutland Region Inc
- Community Health Centers of the Rutland Region, Inc
- Community Health Centers of the Rutland Region, Inc.
- Community Health Centers of the Rutland Region, Inc.
- Clare Conner
- Courtney Lee Connolly
- Convenient Medical Care
- Matthew A Conway
- Patrick J. Cooley
All providers in Rutland, VT · Pediatrics Physician in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2017. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.