NPIMap

Organization Active NPI

Sacopee Valley Health Center

  • Clinic/Center
  • Cornish, ME
National Provider Identifier
1316697154
Registry record updated Feb 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
SACOPEE VALLEY HEALTH CENTER
Practice address
202 Maple St Unit E
Cornish, ME 04020-3147
Phone
(207) 625-8126
Fax
(207) 625-7820
NPI assigned
Mar 25, 2022
Last updated
Feb 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2024

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

Authorized official

Name
Michelle Lee Eastman
Title
Cfo
Phone
(207) 625-8126

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

202 Maple St Unit E
Cornish, ME 04020-3147

Mailing address

70 Main St
Porter, ME 04068-3527
Phone (207) 625-8126

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230531002476 ME Part A Provider - Federally Qualified Health Center (FQHC) 5597664854 Practice locations: Cornish, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316697154. Details of each certification follow.

Federally qualified health center certification: CCN 201024

Legal name
SACOPEE VALLEY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 11, 2023
Last certification
May 11, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 22, 2022 in ME
Enrollment address
202 Maple St
Unit E
Cornish, ME 40203147

Other NPIs with the same Medicare PAC ID 1

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
20D2270474Sacopee Valley Health Center202 Maple St, Cornish, ME 04020Certificate of waiverOct 16, 2026

National Provider Directory

National Provider Directory
Tax ID family
Apple Tree Health Assoc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Michelle Eastman Individual Corporate OfficerCfo Mar 13, 2007
Corporate DirectorCfo Mar 13, 2007
W-2 Managing EmployeeCfo/Authorized Official Mar 13, 2007
Sean Petone Individual Corporate OfficerBoard Member Jun 1, 2009
Ron Adams Individual Corporate OfficerBoard Member Sep 22, 2022
Margaret Zack Individual Corporate OfficerBoard Member Mar 14, 2001
Judy Ingram Individual Corporate OfficerBoard Member Jul 1, 1998
Kevin Ledue Individual Corporate OfficerBoard Member Aug 6, 2019
Douglas Kleinman Individual Corporate OfficerBoard Member Apr 15, 2000
Sara Schroeder Individual Corporate OfficerBoard Member Feb 23, 2023
Betty Lawrence Individual Corporate OfficerBoard Member Aug 14, 2006
Sandra Tate Individual Corporate OfficerBoard Member Apr 12, 2012
Mark Miller Individual Corporate OfficerBoard Member Feb 28, 2025
Linda Watson Individual W-2 Managing EmployeeCeo Jul 29, 1991
Anne R Singleton Individual Corporate OfficerBoard Member Aug 30, 2018

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sacopee Valley Health CenterPorter, ME, CCN 201817 Federally qualified health center Operational/Managerial Control Aug 3, 2010

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1648166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707264000000",
    "number": "1316697154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 MAIN ST",
            "city": "PORTER",
            "state": "ME",
            "postal_code": "040683527",
            "telephone_number": "207-625-8126",
            "fax_number": "207-625-7820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 MAPLE ST UNIT E",
            "city": "CORNISH",
            "state": "ME",
            "postal_code": "040203147",
            "telephone_number": "207-625-8126",
            "fax_number": "207-625-7820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACOPEE VALLEY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-25",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A",
        "authorized_official_last_name": "EASTMAN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "207-625-8126"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cornish, ME

Sources for this page

Verify at the official NPI Registry.