NPIMap

Organization Active NPI

St Croix Regional Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Calais, ME
National Provider Identifier
1083379655
Registry record updated Dec 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ST CROIX REGIONAL FAMILY HEALTH CENTER
Practice address
35 Blue Devil Hill
Calais, ME 04619-0466
Phone
(207) 796-5033
Fax
(207) 796-5528
NPI assigned
Nov 8, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2024

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

Authorized official

Name
Michael Farrell, DCNPI 1962950733
Title
Ceo
Phone
(207) 796-5503

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

35 Blue Devil Hill
Calais, ME 04619-0466

Mailing address

136 Mill St
Princeton, ME 04668-3344
Phone (207) 796-5503

Other names 1

  • Calais Blue Devil Health Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041019000977 ME Part B Supplier - Clinic/Group Practice 3577524024 Receives reassigned benefits from 21 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Princeton, ME; Calais, ME
O20220131002321 ME Part A Provider - Federally Qualified Health Center (FQHC) 3577524024 Practice locations: Calais, ME

Federally qualified health center certification: CCN 201957

Legal name
ST CROIX REGIONAL FAMILY HEALTH CENTER
Doing business as
CALAIS BLUE DEVIL HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 24, 2022
Last certification
Jan 24, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 30, 1991 in ME
Enrollment address
35 Blue Devil HL
Calais, ME 46194037

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
St Croix Regional Family Health Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

35 Blue Devil HL
Calais, ME 04619
Phone (207) 796-5033

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BCGABA

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Angela Hanson Individual Corporate DirectorBoard Member Nov 9, 2012
Karen Sprague Individual Corporate DirectorBoard Member Nov 11, 2013
Peta Brown Individual Corporate DirectorBoard Member Nov 1, 2024
Amy McDonald Individual Corporate DirectorBoard Member Apr 12, 2022
Joanna Emery Individual Corporate DirectorBoard Member Aug 10, 2021
Karen Chesebrough Individual Corporate DirectorBoard Member Jul 9, 2019
Gretchen Cilley Individual Corporate OfficerPatient Accounts Jun 1, 2022
W-2 Managing EmployeePatient Accounts Jun 1, 2022
Miriam Tippin Individual Corporate DirectorBoard Member Nov 14, 2023
John Leighton Individual Corporate DirectorBoard Member Dec 1, 2024
Michael Farrell Individual Corporate OfficerCeo Apr 22, 2024
W-2 Managing EmployeeAd; Apr 22, 2024
Scott Chesebrough Individual Corporate DirectorBoard Member Jul 9, 2019
Michael Marshall Individual Corporate DirectorBoard Member Sep 1, 2006
Nancy Marshall Individual Corporate DirectorBoard Member Nov 9, 2012
Linda Bailey Individual Corporate DirectorBoard Member Sep 1, 2006

Owners & managing parties with NPI records 1

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

Practitioners 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1636329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733875200000",
    "number": "1083379655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 MILL ST",
            "city": "PRINCETON",
            "state": "ME",
            "postal_code": "046683344",
            "telephone_number": "207-796-5503",
            "fax_number": "207-796-5528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 BLUE DEVIL HILL",
            "city": "CALAIS",
            "state": "ME",
            "postal_code": "046190466",
            "telephone_number": "207-796-5033",
            "fax_number": "207-796-5528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CROIX REGIONAL FAMILY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-08",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A",
        "authorized_official_last_name": "FARRELL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-796-5503",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Calais Blue Devil Health",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Calais Blue Devil Health",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Calais, ME

Sources for this page

Verify at the official NPI Registry.