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Gifford Health Care, Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Randolph, VT

NPI 1831782929 · NPPES record last updated Aug 3, 2021

Key facts

NPI
1831782929
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
GIFFORD HEALTH CARE, INC
Practice address
40 S Main St
Randolph, VT 05060
Phone
(802) 728-2420
Fax
(802) 728-2111
NPI assigned
Feb 19, 2021
Organization subpart
No

Authorized official

Name
Daniel Bennett
Title
Ceo
Phone
(802) 728-2211

Owners & managing parties with NPI records 1

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

Owned or controlled facilities with NPI records 1

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

  • Gifford Retirement Community, Inc Nursing Facility/Intermediate Care Facility · Randolph, VT · NPI 1366832230
    CMS ownership 5% OR GREATER DIRECT OWNERSHIP INTEREST · ADP OF THE SNF · DIRECT OWNERSHIP INTEREST · TRUSTEE OF THE SNF

Other NPIs with the same Medicare PAC ID 8

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

Corporate family (same tax ID) 9

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

Practitioners 67

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 67

Medicare participation

Medicare fee-for-service enrollment
Enrolled in VT

Federally qualified health center certification: CCN 471003

Legal name
GIFFORD HEALTH CARE INC
Doing business as
GIFFORD PEDIATRIC & ADOLESCENT MEDICINE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 21, 2024
Last certification
Feb 21, 2024
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Apr 18, 2014 in VT
Enrollment address
40 S Main St
Randolph, VT 50601377

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Kathleen Mason
Individual 		Operational/Managerial Control
Board Member		 Jan 1, 2025
Jody Davignon
Individual 		Corporate Director Jan 1, 2023
Michael K Costa
Individual 		Corporate Director
Chief Executive Officer		 Oct 3, 2024
W-2 Managing Employee
Chief Executive Officer		 Oct 3, 2024
Victor Ribaudo
Individual 		Corporate Director Jan 1, 2023
Cheyenne Holland
Individual 		Corporate Officer
Chief Financial Officer		 Aug 19, 2024
Jeffrey J Nelb
Individual 		Corporate Director Jan 1, 2023
Paul Putney
Individual 		Operational/Managerial Control
Board Member		 Jan 1, 2025
Kristin Chandler
Individual 		Corporate Director Jan 1, 2023
Cindy Rosalbo
Individual 		Operational/Managerial Control
Board Member		 Jan 1, 2025
Sarah Jackson
Individual 		Corporate Director Jan 1, 2023
Morgan Rilling
Individual 		Corporate Director Jan 1, 2023
Jamie Kinnarney
Individual 		Operational/Managerial Control
Board Member		 Jan 1, 2025
Peter Reed
Individual 		Corporate Director Jan 1, 2023
Emilija O Florance
Individual 		Corporate Director Jan 1, 2023
Matthew Considine
Individual 		Corporate Director Jan 1, 2023

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Menig Nursing Home
Randolph Ctr, VT · CCN 475058		 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Trustee of the SNF
Adp of the SNF
Direct Ownership Interest (100%)		 Aug 12, 2013
Aug 12, 2013
Aug 12, 2013
Aug 12, 2013

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20240221002701 VT Part a Provider - Federally Qualified Health Center (FQHC) 2668624982 Practice locations: Randolph, VT

National Provider Directory

Tax ID family
Gifford Health Care Inc (10 organizations share this tax ID)

Locations

40 S Main St
Randolph, VT 05060
Phone (802) 728-2420

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

40 S Main St
Randolph, VT 05060

Mailing address

44 S Main St
Randolph, VT 05060-1378
Phone (802) 728-2760

Other identifiers

IdentifierTypeStateIssuer
0005699MedicaidVT

Other names

  • Gifford Pedicatric and Adolescent Medicine Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 3, 2021.

{
    "created_epoch": "1613692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627948800000",
    "number": "1831782929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 S MAIN ST",
            "city": "RANDOLPH",
            "state": "VT",
            "postal_code": "050601378",
            "telephone_number": "802-728-2760",
            "fax_number": "802-728-2716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 S MAIN ST",
            "city": "RANDOLPH",
            "state": "VT",
            "postal_code": "05060",
            "telephone_number": "802-728-2420",
            "fax_number": "802-728-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIFFORD HEALTH CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-19",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "802-728-2211"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005699",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gifford Pedicatric and Adolescent Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gifford Pedicatric and Adolescent Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Randolph, VT

All providers in Randolph, VT · Federally Qualified Health Center (FQHC) in Vermont

Sources for this page

Verify at the official NPI Registry.