NPIMap

Penobscot Community Health Center

Organization Active NPI Federally Qualified Health Center (FQHC) · Bangor, ME

NPI 1174845697 · NPPES record last updated Aug 6, 2018

Key facts

NPI
1174845697
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
PENOBSCOT COMMUNITY HEALTH CENTER
Practice address
181 Corporate Drive
Bangor, ME 04401
Phone
(207) 992-2636
Fax
(207) 992-2638
NPI assigned
Feb 25, 2010
Organization subpart
Yes
Parent organization (as reported)
PENOBSCOT COMMUNITY HEALTH CENTER

Authorized official

Name
Lori L. Dwyer, ESQ.
Title
President & Ceo
Phone
(207) 992-9200

Other NPIs on the same Medicare enrollment 17

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

Other NPIs with the same Medicare PAC ID 13

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

Corporate family (same tax ID) 39

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

View all 39

Practitioners 136

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

View all 136

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in ME

Federally qualified health center certification: CCN 201899

Legal name
PENOBSCOT COMMUNITY HEALTH CENTER
Doing business as
HOPE HOUSE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 20, 2011
Last certification
Oct 20, 2011
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Sep 4, 1997 in ME
Enrollment address
181 Corporate Dr
Bangor, ME 44014314

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
Mark Doty
Individual 		Corporate Director Jul 1, 2010
Julie Patchell
Individual 		Corporate Director May 1, 2019
Aaron Ballman
Individual 		Corporate Director Sep 1, 2015
Kelley Strout
Individual 		Corporate Director Nov 1, 2017
Alan Duplessis
Individual 		Corporate Director Dec 1, 2013
Christopher Winstead
Individual 		Corporate Director Oct 1, 2012
Christine Finn-McLaughlin
Individual 		Corporate Officer Feb 3, 2015
Corporate Director Feb 3, 2015
W-2 Managing Employee Feb 3, 2015
Operational/Managerial Control Feb 3, 2015
Carin Sychterz
Individual 		Corporate Director Apr 1, 2016
Jennifer Eastman
Individual 		Corporate Director Dec 1, 2009
Monique Gauteau
Individual 		Corporate Director Sep 1, 1997
Ned Robertson
Individual 		Corporate Director Apr 1, 2016
Jacques W Weinstein
Individual 		Corporate Director Apr 1, 2013
Lorelle L Dwyer
Individual 		Corporate Officer Sep 1, 2017
Corporate Director Sep 1, 2017
W-2 Managing Employee Sep 1, 2017
Operational/Managerial Control Sep 1, 2017
Robert Paul Allen
Individual 		Corporate Director May 1, 2016
Mark Woodward
Individual 		Corporate Director May 1, 2011

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040819000698 ME Part B Supplier - Clinic/Group Practice 0143212670 Receives reassigned benefits from 154 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jackman, ME; Old Town, ME; Brewer, ME; Belfast, ME; Bangor, ME
O20111012000118 ME Part a Provider - Federally Qualified Health Center (FQHC) 0143212670 Practice locations: Bangor, ME

National Provider Directory

Tax ID family
Penobscot Community Health Care (40 organizations share this tax ID)
Part of
Penobscot Community Health Care

Locations

992 Union St
Ste 5
Bangor, ME 04401
Phone (207) 992-2601

Specialties & licenses

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

Addresses

Primary practice location

181 Corporate Drive
Bangor, ME 04401

Mailing address

PO Box 1599
Bangor, ME 04402-1599
Phone (207) 992-9200

Other names

  • Hope House Health Center Doing business as

Other providers in Bangor, ME

All providers in Bangor, ME · Federally Qualified Health Center (FQHC) in Maine

Sources for this page

Verify at the official NPI Registry.