Northwest Community Health Care
Organization Active NPI Federally Qualified Health Center (FQHC) · Foster, RI
NPI 1821254525 · NPPES record last updated Oct 21, 2011
Key facts
- NPI
- 1821254525
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- NORTHWEST COMMUNITY HEALTH CARE
- Practice address
- 142A Danielson Pike
Foster, RI 02825-1475 - Phone
- (401) 647-3702
- Fax
- (401) 647-5380
- NPI assigned
- Aug 1, 2008
- Organization subpart
- No
Authorized official
- Name
- Mr. Peter J Bancroft
- Title
- President & Ceo
- Phone
- (401) 285-5119
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 3
Practitioners 39
-
John Paul Carvalho, PH.D.
-
Saima Kane, FNP
-
Joseph Albertario, PMHNP-BC
-
Missy Buco, APRN
-
Nicole D. Burns, NP
-
Nicole Coggins, PMHNP
-
Carolyn Cote, NP
-
Nikia Dasilva-Lopes, LCSW
-
Steven K Diehl, PHD
-
Linda T Eibel, NP
-
Chelsea Farias, PA-C
-
Stephanie Forget, N.P.
-
Charles D Fraser, FNP
-
Jessica Gawrys, PA
-
Mary Louise Giovetti, M.D.
-
Clifford I Gordon, ED.D.
-
Michala Lynn Jorrin, CRNP
-
Mariam Kanteh, PA-C
-
Lesley B Landau, PHD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in RI
Federally qualified health center certification: CCN 411841
- Legal name
- NORTHWEST COMMUNITY HEALTH CARE
- Doing business as
- WELLONE PRIMARY MEDICAL AND DENTAL CARE
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 20, 2008
- Last certification
- Oct 20, 2008
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 23, 1909 in RI
- Enrollment address
- 142A Danielson Pike
Foster, RI 28251475
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| David H. Ferrara |
Corporate Officer |
Nov 1, 2010 | |
| Peter John Bancroft |
Corporate Director |
Sep 1, 2008 | |
| W-2 Managing Employee |
Sep 1, 2008 | ||
| Christine L Vallee |
Corporate Director |
Nov 1, 2008 | |
| Margaret Dudley |
Corporate Director | Oct 1, 2021 | |
| Keith Mailloux |
Corporate Director |
Nov 1, 2011 | |
| Diane Hopper |
W-2 Managing Employee | Sep 1, 2008 | |
| Andrea Marcotte |
W-2 Managing Employee |
Sep 1, 2008 | |
| Darya Kravitz |
Corporate Director | Oct 1, 2020 | |
| Crystal L Leddy |
Corporate Director |
Nov 1, 2011 | |
| Dennis Anderson |
Corporate Director | Oct 1, 2017 | |
| Deirdre Norton |
W-2 Managing Employee | Sep 1, 2008 | |
| David Dejesus |
Corporate Director | Oct 1, 2017 | |
| Sarah Nottage |
Corporate Director |
Nov 1, 2011 | |
| Roberta Lacey |
Corporate Director | Oct 1, 2023 | |
| Gerald Goulet |
Corporate Officer |
Oct 1, 2017 | |
| Joan Hilton |
Corporate Director |
Nov 1, 2010 | |
| Joseph Casey |
Corporate Director |
Oct 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050308000422 | RI | Part B Supplier - Clinic/Group Practice | 1355250663 |
Receives reassigned benefits from 49 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Pascoag, RI; North Scituate, RI; North Kingstown, RI; Foster, RI |
| O20080821000540 | RI | Part a Provider - Federally Qualified Health Center (FQHC) | 1355250663 | Practice locations: Foster, RI |
National Provider Directory
Locations
142A Danielson Pike
Foster, RI 02825
Phone (401) 241-1924
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
142A Danielson Pike
Foster, RI 02825-1475
Mailing address
PO Box 312
Pascoag, RI 02859
Phone (401) 568-7664
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NC50602 | Medicaid | RI |
Other names
- WellOne Primary Medical and Dental Care
Other providers in Foster, RI
- Katherine Mary Moore
- Christian P. Mueller
- Wendy Mumford
- Nancy Ann Nursing Home, Inc.
- Carol Niederer
- Kanchan Pande
- Potterville Fire Department Inc
- Pugliese Natural Medicine PLLC
- Nancy Ann Puth
- Rising Hope Counseling Services, LLC
All providers in Foster, RI · Federally Qualified Health Center (FQHC) in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 21, 2011. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.