NPIMap

Organization Active NPI

Indian Township Tribal Government

Doing business as Passamaquoddy Health Center

  • Federally Qualified Health Center (FQHC)
  • Princeton, ME
National Provider Identifier
1205952140
Registry record updated Sep 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
INDIAN TOWNSHIP TRIBAL GOVERNMENT
Doing business as
Passamaquoddy Health Center
Practice address
401 Peter Dana Point Road
Princeton, ME 04668-0097
Phone
(207) 796-2321
Fax
(207) 796-2422
NPI assigned
Mar 22, 2007
Last updated
Sep 28, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
PASSAMAQUODDY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 28, 2020

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

Authorized official

Name
Andrea M Hanson, TRIBAL CHIEF
Title
Compliance Specialist
Phone
(207) 796-2321

Specialties & licenses 1

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

Addresses

Primary practice location

401 Peter Dana Point Road
Princeton, ME 04668-0097

Mailing address

PO Box 97
401 Peter Dana Point Rd
Princeton, ME 04668-0097
Phone (207) 796-2321

Other identifiers 1

IdentifierTypeStateIssuer
107940000MedicaidME

Other names 1

  • PASSAMAQUODDY HEALTH CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME, TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101109000079 ME Part A Provider - Federally Qualified Health Center (FQHC) 6103914445 Practice locations: Indian TWP, ME
O20211124000165 TX Part B Supplier - Clinic/Group Practice 6103914445 Receives reassigned benefits from 11 practitioners
Practice locations: Indian TWP, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205952140. Details of each certification follow.

Federally qualified health center certification: CCN 201825

Legal name
INDIAN TOWNSHIP TRIBAL GOVERNMENT
Doing business as
PASSAMAQUODDY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 22, 1994
Last certification
Aug 22, 1994
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
401 Peter Dana Point Rd
Indian TWP, ME 46685007

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Indian Township Tribal Government4 organizations share this tax ID, including this one
Part of
Indian Township Tribal Government

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Carol Francis Individual Corporate DirectorDirector Sep 1, 2021 100%
Indian Township Tribal Government Organization, Princeton, ME Operational/Managerial Control Aug 1, 1994 100%
Andrea Hanson Individual W-2 Managing EmployeeCompliance Specialist/Credentialing Jan 1, 2019 100%
William Nicholas Individual Corporate OfficerTribal Chief Jan 1, 2018 100%
Operational/Managerial ControlTribal Chief Oct 1, 2014 100%

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 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601251200000",
    "number": "1205952140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 97",
            "address_2": "401 PETER DANA POINT RD",
            "city": "PRINCETON",
            "state": "ME",
            "postal_code": "046680097",
            "telephone_number": "207-796-2321",
            "fax_number": "207-796-2422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 PETER DANA POINT ROAD",
            "city": "PRINCETON",
            "state": "ME",
            "postal_code": "046680097",
            "telephone_number": "207-796-2321",
            "fax_number": "207-796-2422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN TOWNSHIP TRIBAL GOVERNMENT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PASSAMAQUODDY HEALTH CENTER",
        "enumeration_date": "2007-03-22",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "COMPLIANCE SPECIALIST",
        "authorized_official_telephone_number": "207-796-2321",
        "authorized_official_credential": "TRIBAL CHIEF"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "ME",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107940000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PASSAMAQUODDY HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Princeton, ME

Sources for this page

Verify at the official NPI Registry.