Maine Mobile Health Program, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

MAINE MOBILE HEALTH PROGRAM, INC.

Practice address

79 Leighton Rd
Augusta, ME 04330-7747

Phone

(207) 622-9252

Fax

(207) 626-7612

NPI assigned

Nov 2, 2011

Organization subpart

No

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

Authorized official

Name

Amelia Rukema

Title

Chief Executive Officer

Phone

(207) 557-0870

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ME2 enrollments

Enrollment records 2

Federally qualified health center certification: CCN 201821

Legal name

MAINE MOBILE HEALTH PROGRAM, INC.

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

May 15, 1994

Last certification

May 15, 1994

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Oct 8, 2003 in ME

Enrollment address

79 Leighton Rd
Augusta, ME 4330

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 7

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

Practitioners 3

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

• Demetri Blanas, MD

  • Family Medicine Physician
  • Zuni, NM
  • NPI 1619316825

  ME

  Medicare reassignment
• Laura Elizabeth Valencia Orozco

  • Mental Health Counselor
  • Augusta, ME
  • NPI 1952008310
  NPD
• Garrett Fontaine, MD

  • Family Medicine Physician
  • Waterville, ME
  • NPI 1679140818
  NPD (past)

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

{
    "created_epoch": "1320192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759363200000",
    "number": "1376829598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 405",
            "city": "AUGUSTA",
            "state": "ME",
            "postal_code": "043320405",
            "telephone_number": "207-622-9252",
            "fax_number": "207-626-7612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79 LEIGHTON RD",
            "city": "AUGUSTA",
            "state": "ME",
            "postal_code": "043307747",
            "telephone_number": "207-622-9252",
            "fax_number": "207-626-7612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINE MOBILE HEALTH PROGRAM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-02",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "status": "A",
        "authorized_official_last_name": "RUKEMA",
        "authorized_official_first_name": "AMELIA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "207-557-0870"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maine Behavioral Health Organization
• Maine CDC Public Health Nursing
• Maine Dental Group, P.C.
• Maine Endodontics PA
• Maine Laser Skin Care, P.a.
• Maine Mobile MRI Assoc (Maine MRI Associates)
• Maine Mobile MRI Associates
• Maine Office of Child and Family Services
• Maine Parent Federation, Inc.
• Maine Physical Therapy Limited Partnership

• Federally Qualified Health Center (FQHC) in Augusta, ME
• Providers in Augusta, 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 Oct 2, 2025; 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.