Eastport Health Care, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

EASTPORT HEALTH CARE, INC.

Practice address

160 Dublin St
Machias, ME 04654-3409

Phone

(207) 255-8290

Fax

(207) 853-6180

NPI assigned

Jun 14, 2011

Last updated

Jan 8, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Wanda Matthews

Title

Cfo

Phone

(207) 853-0180

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in ME2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295020691. Details of each certification follow.

• CCN 201027 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 201027

Legal name

EASTPORT HEALTH CARE, INC

Doing business as

EHC MACHIAS

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Aug 9, 2023

Last certification

Aug 9, 2023

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Jan 1, 1990 in ME

Enrollment address

160 Dublin St
Machias, ME 46543409

Other NPIs with the same Medicare PAC ID 1

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

• Eastport Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Eastport, ME
  • NPI 1093752917

  3577592880

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

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

• Eastport Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Eastport, ME
  • NPI 1093752917

  O20180503002570

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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.

Practitioners 15

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.

• Albert Frederick Hartman Jr., MD

  • Family Medicine Physician
  • Lewiston, ME
  • NPI 1790110237
  NPD
• Lisa Jacobs, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Bangor, ME
  • NPI 1568554186
  NPD
• Susan L. Luthin, M.D.

  • Family Medicine Physician
  • Dover Foxcroft, ME
  • NPI 1356383962
  NPD
• Sandra Manship, APRN-CNP

  • Family Nurse Practitioner
  • Machias, ME
  • NPI 1215368881
  NPD
• Jordan S Porter, DNP

  • Family Nurse Practitioner
  • Scarborough, ME
  • NPI 1285286591
  NPD
• Tiffany Presnell, LCSW

  • Clinical Social Worker
  • Bangor, ME
  • NPI 1629472782
  NPD
• William B Richardson, MD

  • Family Medicine Physician
  • Eastport, ME
  • NPI 1457409617
  NPD
• Laura Malone Wakeman, LCSW-C

  • Clinical Social Worker
  • Machias, ME
  • NPI 1053921437
  NPD
• Bryan Franklin Armstrong, P-LCSW, P-LCAS

  • Clinical Social Worker
  • Charlotte, NC
  • NPI 1245554617
  NPD
• Kelly Leslie, APRN-FNP-C

  • Family Nurse Practitioner
  • Woodward, OK
  • NPI 1447896147
  NPD
• Robert W Phares, MD

  • Family Medicine Physician
  • Oakland, MD
  • NPI 1083666598
  NPD
• Pradheep J Shanker, M.D.

  • Body Imaging Physician
  • Columbus, OH
  • NPI 1457399818
  NPD

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

{
    "created_epoch": "1308009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1295020691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX H",
            "city": "EASTPORT",
            "state": "ME",
            "postal_code": "046310909",
            "telephone_number": "207-853-6001",
            "fax_number": "207-853-4031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 DUBLIN ST",
            "city": "MACHIAS",
            "state": "ME",
            "postal_code": "046543409",
            "telephone_number": "207-255-8290",
            "fax_number": "207-853-6180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTPORT HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-14",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A",
        "authorized_official_last_name": "MATTHEWS",
        "authorized_official_first_name": "WANDA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "207-853-0180"
    },
    "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": "1295020691",
            "state": "ME"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wmatthews@eastporthealth.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "address_1": "160 Dublin St",
            "city": "Machias",
            "state": "ME",
            "country_code": "US",
            "postal_code": "046543409",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wmatthews@eastporthealth.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "160 Dublin St",
            "city": "Machias",
            "state": "ME",
            "country_code": "US",
            "postal_code": "046543409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Federally Qualified Health Center (FQHC) in Machias, ME
• Providers in Machias, ME by specialty
• Federally Qualified Health Center (FQHC) in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.