NPIMap

Organization Active NPI

Katahdin Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Millinocket, ME
National Provider Identifier
1003034406
Registry record updated Dec 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
KATAHDIN VALLEY HEALTH CENTER
Practice address
50 Summer St
Millinocket, ME 04462-1400
Phone
(207) 723-6565
Fax
(207) 723-6564
NPI assigned
Apr 23, 2007
Last updated
Dec 20, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2016

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

Authorized official

Name
Claudette G Humphrey
Title
Ceo
Phone
(207) 528-2285

Specialties & licenses 1

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

Addresses

Primary practice location

50 Summer St
Millinocket, ME 04462-1400

Mailing address

529 S Patten Rd
Patten, ME 04765-3007
Phone (207) 528-2285

Other identifiers 1

IdentifierTypeStateIssuer
168260104MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041130000688 ME Part B Supplier - Clinic/Group Practice 4880659903 Receives reassigned benefits from 82 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ashland, ME; Patten, ME; Millinocket, ME; Lincoln, ME; Houlton, ME; Dover Foxcroft, ME; Brownville, ME
O20110815000073 ME Part A Provider - Federally Qualified Health Center (FQHC) 4880659903 Practice locations: Millinocket, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003034406. Details of each certification follow.

Federally qualified health center certification: CCN 201898

Legal name
KATAHDIN VALLEY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 18, 2011
Last certification
Aug 18, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 12, 1974 in ME
Enrollment address
50 Summer Street
Millinocket, ME 44621400

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/7377/brand/1/csg/1/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Rhonda R Brophy Individual Corporate Director Feb 17, 2010
Brandi Stevenson Individual Corporate DirectorBoard Member - Treasurer Nov 17, 2021
Kathy White Individual Corporate DirectorBoard Member Nov 23, 2022
Jason Parent Individual Corporate DirectorBoard Member Oct 27, 2021
Chris M Nickerson Individual Corporate Director May 25, 2008
Alicia Stone Individual Corporate DirectorBoard Member Oct 27, 2021
John Arthur Doe Individual Corporate Director Mar 30, 2005
Chad R Perkins Individual Corporate DirectorBoard Member Apr 27, 2016
Charity Rudge Individual Corporate OfficerBilling Manager Dec 1, 2020
W-2 Managing EmployeeBilling Manager Mar 1, 2022
Kathleen P Case Individual Corporate DirectorBoard Member Jan 29, 2014
Claudette G Humphrey Individual Corporate OfficerCeo Jul 31, 2016
W-2 Managing EmployeeCeo Jul 31, 2016

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482192000000",
    "number": "1003034406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "529 S PATTEN RD",
            "city": "PATTEN",
            "state": "ME",
            "postal_code": "047653007",
            "telephone_number": "207-528-2285",
            "fax_number": "207-528-2880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 SUMMER ST",
            "city": "MILLINOCKET",
            "state": "ME",
            "postal_code": "044621400",
            "telephone_number": "207-723-6565",
            "fax_number": "207-723-6564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATAHDIN VALLEY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2016-12-20",
        "status": "A",
        "authorized_official_last_name": "HUMPHREY",
        "authorized_official_first_name": "CLAUDETTE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-528-2285"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168260104",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Millinocket, ME

Sources for this page

Verify at the official NPI Registry.