NPIMap

Organization Active NPI

Gifford Health Care, Inc

Doing business as Gifford Pedicatric and Adolescent Medicine

  • Federally Qualified Health Center (FQHC)
  • Randolph, VT
National Provider Identifier
1831782929
Registry record updated Aug 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GIFFORD HEALTH CARE, INC
Doing business as
Gifford Pedicatric and Adolescent Medicine
Practice address
40 S Main St
Randolph, VT 05060
Phone
(802) 728-2420
Fax
(802) 728-2111
NPI assigned
Feb 19, 2021
Last updated
Aug 3, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2021

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

Authorized official

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

Specialties & licenses 1

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

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 1

IdentifierTypeStateIssuer
0005699MedicaidVT

Other names 1

  • Gifford Pedicatric and Adolescent Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831782929. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Apr 18, 2014 in VT
Enrollment address
40 S Main St
Randolph, VT 50601377

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
Gifford Health Care Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

2418 Airport Rd
Ste 1
Barre, VT 05641
Phone (802) 224-3200

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

Ownership & related parties

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 ControlBoard Member Jan 1, 2025
Jody Davignon Individual Corporate Director Jan 1, 2023
Michael K Costa Individual Corporate DirectorChief Executive Officer Oct 3, 2024
W-2 Managing EmployeeChief Executive Officer Oct 3, 2024
Victor Ribaudo Individual Corporate Director Jan 1, 2023
Cheyenne Holland Individual Corporate OfficerChief Financial Officer Aug 19, 2024
Jeffrey J Nelb Individual Corporate Director Jan 1, 2023
Paul Putney Individual Operational/Managerial ControlBoard Member Jan 1, 2025
Kristin Chandler Individual Corporate Director Jan 1, 2023
Cindy Rosalbo Individual Operational/Managerial ControlBoard 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 ControlBoard 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

Owners & managing parties with NPI records 1

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

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 HomeRandolph 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

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

    dba Menig Nursing Home

    • Nursing Facility/Intermediate Care Facility
    • Randolph, VT
    • NPI 1366832230

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Direct Ownership Interest, Trustee of the SNF

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 61

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 61

NPI Registry JSON

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

{
    "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

Sources for this page

Verify at the official NPI Registry.