NPIMap

Organization Active NPI

Speare Memorial Hospital

  • Rural Health Clinic/Center
  • Plymouth, NH
National Provider Identifier
1841342540
Registry record updated Apr 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
01300 Issued in NH
Legal business name
SPEARE MEMORIAL HOSPITAL
Practice address
103 Boulder Point Drive
Plymouth, NH 03264
Phone
(603) 536-1881
Fax
(603) 238-2198
NPI assigned
Jan 16, 2007
Last updated
Apr 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2023

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

Authorized official

Name
Michelle L McEwen
Title
President/Ceo
Phone
(603) 536-1120

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 01300 NH Primary
Physician Assistant 363A00000X
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X

Addresses

Primary practice location

103 Boulder Point Drive
Plymouth, NH 03264

Mailing address

16 Hospital Rd
Plymouth, NH 03264-1126
Phone (603) 238-2204

Other identifiers 3

IdentifierTypeStateIssuer
30517874MedicaidNH
1017704MedicaidVT
3083028MedicaidNH

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060922000264 NH Part B Supplier - Clinic/Group Practice 1153318068 Receives reassigned benefits from 19 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Plymouth, NH
O20071018000604 NH Part A Provider - Rural Health Clinic 1153318068 Practice locations: Plymouth, NH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841342540. Details of each certification follow.

Rural health clinic certification: CCN 303987

Legal name
SPEARE MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 15, 2009
Last certification
May 10, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 27, 1942 in NH
Enrollment address
103 Boulder Point Dr
Plymouth, NH 03264-3168
Related CCNs
301311

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

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
Elizabeth Kleiner Individual Corporate DirectorBoard Member Oct 31, 2019
Susan Scrimshaw Individual Corporate Director Oct 21, 2021
John Moulton Individual Corporate DirectorBoard Member Nov 1, 2024
Joseph T Caristi Individual Corporate OfficerCfo Feb 19, 2024
Corporate DirectorCfo Feb 19, 2024
W-2 Managing EmployeeCfo Feb 19, 2024
Operational/Managerial ControlCfo Feb 19, 2024
Margaret Turner Individual Corporate DirectorBoard Member Sep 1, 2014
Patrick B Miller Individual Corporate DirectorBoard Member Oct 19, 2017
Joseph a Ebner Individual Corporate DirectorChief Medical Director Jan 1, 2008
W-2 Managing EmployeeMD; Jan 1, 2008
Operational/Managerial ControlChief Medical Director Jan 1, 2008
Kevin I Young Individual Corporate DirectorBoard Member Sep 1, 2014
Walter Johnson Individual Corporate DirectorBoard Member Oct 25, 2018
Steven Camerino Individual Corporate Director Oct 23, 2019
Donna Driscoll Individual Corporate DirectorBoard Member Nov 1, 2024
Ken Evans Individual Corporate DirectorBoard Member Nov 1, 2024
Julie Bernier Individual Corporate DirectorBoard Member Oct 25, 2018
Michelle L McEwen Individual Corporate OfficerPresidnet/Ceo Dec 28, 1992
Corporate DirectorPresident/Ceo Dec 28, 1992
W-2 Managing EmployeePresident/Ceo Dec 28, 1992
Operational/Managerial ControlPresident/Ceo Dec 28, 1992
Dolores C Hopper Individual Corporate Director Oct 27, 2022

Owners & managing parties with NPI records 1

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

  • Joseph A Ebner, MD
    • Obstetrics & Gynecology Physician
    • Plymouth, NH
    • NPI 1881602472

    Corporate Director, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682553600000",
    "number": "1841342540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 HOSPITAL RD",
            "city": "PLYMOUTH",
            "state": "NH",
            "postal_code": "032641126",
            "telephone_number": "603-238-2204",
            "fax_number": "603-536-2034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 BOULDER POINT DRIVE",
            "city": "PLYMOUTH",
            "state": "NH",
            "postal_code": "03264",
            "telephone_number": "603-536-1881",
            "fax_number": "603-238-2198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPEARE MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2023-04-27",
        "certification_date": "2023-04-27",
        "status": "A",
        "authorized_official_last_name": "MCEWEN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "603-536-1120"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NH",
            "license": "01300",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30517874",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1017704",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3083028",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, NH

Sources for this page

Verify at the official NPI Registry.