NPIMap

Organization Active NPI

Northern Counties Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Island Pond, VT
National Provider Identifier
1992822555
Registry record updated Jan 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHERN COUNTIES HEALTH CARE, INC.
Practice address
82 Maple Street
Island Pond, VT 05846
Phone
(802) 723-4300
Fax
(802) 723-4544
NPI assigned
Mar 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2014

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

Authorized official

Name
Patrick Flood
Title
Executive Director/Ceo
Phone
(802) 748-9405

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Health Service Clinic/Center 261QH0100X
Clinical Medical Laboratory 291U00000X

Addresses

Primary practice location

82 Maple Street
Island Pond, VT 05846

Mailing address

165 Sherman Drive
St Johnsbury, VT 05819
Phone (802) 748-9405

Other identifiers 2

IdentifierTypeStateIssuer
0473811MedicaidVT
471804OtherVTMEDICARE PROVIDER NUMBER

Other names 1

  • Island Pond Health & Dental Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100825000939 VT Part A Provider - Federally Qualified Health Center (FQHC) 2860300936 Practice locations: Island Pond, VT

Federally qualified health center certification: CCN 471804

Legal name
NORTHERN COUNTIES HEALTH CARE INC
Doing business as
ISLAND POND HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Sep 19, 1976 in VT
Enrollment address
82 Maple St
Island Pond, VT 5846

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Hardwick Area HLTH Cent17 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

165 Sherman Dr
St Johnsbury, VT 05819
Phone (802) 748-9405

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
Angela Neil Individual Corporate OfficerCfo Feb 1, 2021
W-2 Managing EmployeeAd; Feb 1, 2021
Patricia Aubin Individual Corporate Director Oct 15, 2023
Stacey Henderson Individual Corporate Director Jan 22, 2025
Adrianne Hutchin Individual Corporate Director Oct 15, 2022
Justin Barton-Caplin Individual Corporate Director Oct 15, 2020
Jane Chung Individual Corporate Director Oct 25, 2023
Christopher E Towne Individual Corporate OfficerCeo Oct 1, 2024
W-2 Managing EmployeeAd; Oct 1, 2024
Laura Newell Individual Corporate Director Oct 15, 2019
Shari-Lee Ryan Individual Corporate Director Jan 22, 2025
Otto Worzburg Individual Corporate Director Jan 22, 2025
Sarah Rebecca Galloway Individual Corporate Director Oct 15, 2020
Rita Laferriere Individual Corporate Director Nov 20, 2024
Maryellen Griffin Individual Corporate Director Oct 15, 2020
Louisa Driscoll Individual Corporate Director Oct 15, 2020
Sophia Boyle Hall Individual Corporate Director Oct 15, 2020

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391040000000",
    "number": "1992822555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 SHERMAN DRIVE",
            "city": "ST JOHNSBURY",
            "state": "VT",
            "postal_code": "05819",
            "telephone_number": "802-748-9405",
            "fax_number": "802-748-4540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 MAPLE STREET",
            "city": "ISLAND POND",
            "state": "VT",
            "postal_code": "05846",
            "telephone_number": "802-723-4300",
            "fax_number": "802-723-4544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN COUNTIES HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2014-01-30",
        "status": "A",
        "authorized_official_last_name": "FLOOD",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR/CEO",
        "authorized_official_telephone_number": "802-748-9405"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0473811",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "471804",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Island Pond Health & Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Island Pond, VT

Sources for this page

Verify at the official NPI Registry.