NPIMap

Organization Active NPI

Mercy Hospital

Doing business as Northern Light Mercy Health Center

  • Rural Health Clinic/Center
  • Windham, ME
National Provider Identifier
1396496378
Registry record updated Apr 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MERCY HOSPITAL
Doing business as
Northern Light Mercy Health Center
Northern Light Mercy Hospital
Practice address
409 Roosevelt TRL
Windham, ME 04062-4821
Phone
(207) 400-8618
NPI assigned
Jan 12, 2022
Last updated
Apr 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2024

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

Authorized official

Name
David Patrick Kennedy
Title
VP Finance
Phone
(207) 879-3363

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

409 Roosevelt TRL
Windham, ME 04062-4821

Mailing address

175 Fore River Pkwy
Portland, ME 04102-2779

Other names 2

  • Northern Light Mercy Health Center Doing business as
  • Northern Light Mercy Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220617001130 ME Part A Provider - Rural Health Clinic 6103737812 Practice locations: Windham, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396496378. Details of each certification follow.

Rural health clinic certification: CCN 208529

Legal name
MERCY HOSPITAL
Doing business as
NORTHERN LIGHT HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 29, 2023
Last certification
Jun 29, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Feb 6, 1945 in ME
Enrollment address
409 Roosevelt TRL
Windham, ME 04062-4821
Related CCNs
200008

Facilities connected through Provider of Services related, parent or unit certification numbers.

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
Mercy Hospial7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

413 Alfred St
Ste 201
Biddeford, ME 04005
Phone (207) 282-2202

75 Clearwater Dr
Ste 106
Falmouth, ME 04105
Phone (207) 400-8570

77 Gray Rd
W Falmouth Family Practice
Falmouth, ME 04105
Phone (207) 535-1340

117 Auburn St
Portland, ME 04103
Phone (207) 797-4445

1364 Congress St
Ste 3
Portland, ME 04102
Phone (207) 400-8530

155 Fore River Pkwy
Portland, ME 04102
Phone (207) 535-1100

155 Fore River Pkwy
Ste 110
Portland, ME 04102
Phone (207) 879-3190

155 Fore River Pkwy
Ste 130
Portland, ME 04102
Phone (207) 535-1100

195 Fore River Pkwy
Ste 100
Portland, ME 04102
Phone (207) 553-6177

195 Fore River Pkwy
Ste 110
Portland, ME 04102
Phone (207) 553-6500

195 Fore River Pkwy
Ste 160
Portland, ME 04102
Phone (207) 553-6700

195 Fore River Pkwy
Ste 250
Portland, ME 04102
Phone (207) 553-6800

195 Fore River Pkwy
Ste 300
Portland, ME 04102
Phone (207) 553-6000

195 Fore River Pkwy
Ste 360
Portland, ME 04102
Phone (207) 553-6868

195 Fore River Pkwy
Ste 460
Portland, ME 04102
Phone (207) 879-3770

43 Baxter Blvd
Ste 2
Portland, ME 04101
Phone (207) 771-1717

959 Congress St
Portland, ME 04102
Phone (207) 523-5901

225 Gorham Rd
Ste 303
South Portland, ME 04106
Phone (207) 535-1880

25 Long Creek Dr
Ste 3
South Portland, ME 04106
Phone (207) 535-1100

778 Main St
Ste 1
South Portland, ME 04106
Phone (207) 535-1880

111 Ossipee Trl E
Ste 1142
Standish, ME 04084
Phone (207) 642-4434

174 Kennedy Memorial Dr
Waterville, ME 04901
Phone (207) 861-3338

40 Park Rd
Westbrook, ME 04092
Phone (207) 857-8174

409 Roosevelt Trl
Ste 1
Windham, ME 04062
Phone (207) 400-8600

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
David Kennedy Individual Corporate Director Aug 20, 2020
W-2 Managing Employee Aug 20, 2020
Eastern Maine Healthcare Services Organization, Brewer, ME Non-profit 5% Or Greater Direct Ownership Interest Oct 1, 2013 100%
Charlie Therrien Individual Corporate OfficerPresident Nov 14, 2016 100%
Debra D Taylor Individual Corporate Director Oct 1, 2013

Facilities with the same owner 15

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 15

Practitioners & affiliated clinicians

Practitioners 568

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 568

NPI Registry JSON

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

{
    "created_epoch": "1641945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712880000000",
    "number": "1396496378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 FORE RIVER PKWY",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 ROOSEVELT TRL",
            "city": "WINDHAM",
            "state": "ME",
            "postal_code": "040624821",
            "telephone_number": "207-400-8618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-12",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "207-879-3363"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Light Mercy Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northern Light Mercy Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Windham, ME

Sources for this page

Verify at the official NPI Registry.