NPIMap

Organization Active NPI

Mid-State Health Center

  • Internal Medicine Physician
  • Plymouth, NH
National Provider Identifier
1811156409
Registry record updated Jun 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MID-STATE HEALTH CENTER
Practice address
101 Boulder Point Dr
Suite 1
Plymouth, NH 03264-3170
Phone
(603) 536-4000
Fax
(603) 536-4001
NPI assigned
Jun 9, 2008
Last updated
Jun 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2025

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

Authorized official

Name
Robert Macleod
Title
Ceo
Phone
(603) 536-4000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU Primary
Diagnostic Radiology Physician 2085R0202X NU

Addresses

Primary practice location

101 Boulder Point Dr
Suite 1
Plymouth, NH 03264-3170

Mailing address

101 Boulder Point Dr
Suite 1
Plymouth, NH 03264-3170
Phone (603) 536-4000

Other identifiers 4

IdentifierTypeStateIssuer
30009302MedicaidNH
301818OtherNHMEDICARE PART A BRISTOL
301817OtherNHMEDICARE PART A PLYMOUTH
3073404MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041027000215 NH Part B Supplier - Clinic/Group Practice 1951363563 Receives reassigned benefits from 40 practitioners
7 other NPIs on this enrollment
Practice locations: Bristol, NH; Lincoln, NH; Plymouth, NH
O20221101002260 NH DME Supplier - Multi-Specialty - Physician 1951363563 Practice locations: Plymouth, NH

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
Sma Bristol17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Locations

202 Cottage St
Littleton, NH 03561
Phone (603) 626-9000

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mid-State Health CenterPlymouth, NH, CCN 301817 Federally qualified health center Operational/Managerial Control Jan 9, 1998

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 41

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 41

NPI Registry JSON

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

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750118400000",
    "number": "1811156409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BOULDER POINT DR",
            "address_2": "SUITE 1",
            "city": "PLYMOUTH",
            "state": "NH",
            "postal_code": "032643170",
            "telephone_number": "603-536-4000",
            "fax_number": "603-536-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BOULDER POINT DR",
            "address_2": "SUITE 1",
            "city": "PLYMOUTH",
            "state": "NH",
            "postal_code": "032643170",
            "telephone_number": "603-536-4000",
            "fax_number": "603-536-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID-STATE HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-09",
        "last_updated": "2025-06-17",
        "certification_date": "2025-06-17",
        "status": "A",
        "authorized_official_last_name": "MACLEOD",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "603-536-4000"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30009302",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART A BRISTOL",
            "identifier": "301818",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART A PLYMOUTH",
            "identifier": "301817",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3073404",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, NH

Sources for this page

Verify at the official NPI Registry.