NPIMap

Organization Active NPI

Portland Community Health Center

Doing business as Greater Portland Health

  • Federally Qualified Health Center (FQHC)
  • Portland, ME
National Provider Identifier
1407695059
Registry record updated Sep 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PORTLAND COMMUNITY HEALTH CENTER
Doing business as
Greater Portland Health
Practice address
295 Park Ave
Portland, ME 04102-2911
Phone
(207) 874-2141
Fax
(207) 761-3738
NPI assigned
May 22, 2024
Last updated
Sep 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2024

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

Authorized official

Name
Ann F Tucker
Title
Ceo
Phone
(207) 874-2141

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Non-emergency Medical Transport (VAN) 343900000X

Addresses

Primary practice location

295 Park Ave
Portland, ME 04102-2911

Mailing address

180 Park Ave
Portland, ME 04102-2957
Phone (207) 874-2141

Other names 1

  • Greater Portland Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240906002461 ME Part A Provider - Federally Qualified Health Center (FQHC) 5395998017 Practice locations: Portland, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407695059. Details of each certification follow.

Federally qualified health center certification: CCN 201036

Legal name
PORTLAND COMMUNITY HEALTH CENTER
Doing business as
GREATER PORTLAND HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 6, 2024
Last certification
Sep 6, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 30, 2013 in ME
Enrollment address
295 Park Ave
Portland, ME 41022911

Other NPIs with the same Medicare PAC ID 17

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

View all 17

National Provider Directory

National Provider Directory
Tax ID family
Portland Community Health Center43 organizations share this tax ID, including this one

Other organizations with this tax ID 42

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

View all 42

Locations

295 Park Ave
Portland, ME 04102
Phone (207) 662-2004

295 Park Ave
Ste A
Portland, ME 04102

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Axel Nimbona Individual Corporate DirectorBoard Member Apr 16, 2024
Ann Tucker Individual Corporate OfficerCeo Apr 4, 2018
W-2 Managing Employee Apr 4, 2018
Paul Santomenna Individual Corporate DirectorBoard Member Dec 26, 2017
Belviga Mpolo Individual Corporate DirectorBoard Member Jan 27, 2026
Christine Caulfield Individual Corporate DirectorBoard Member Jan 24, 2023
Connor O'Neill Individual Corporate DirectorBoard Member Apr 16, 2024
Christopher Dana Individual Corporate DirectorBoard Member Jul 27, 2021
Isaac Macdougal Individual Corporate DirectorBoard Member Apr 16, 2024
Marie a Guay Individual Corporate DirectorBoard Member Apr 16, 2024
Richard M White Individual Corporate DirectorBoard Member Jan 24, 2017
Doreen Karigirwa Individual Corporate DirectorBoard Member Jan 27, 2026
John Dearmond Individual Corporate DirectorBoard Member Jan 27, 2026

NPI Registry JSON

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

{
    "created_epoch": "1716336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725321600000",
    "number": "1407695059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 PARK AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022957",
            "telephone_number": "207-874-2141",
            "fax_number": "207-761-3738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 PARK AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022911",
            "telephone_number": "207-874-2141",
            "fax_number": "207-761-3738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-22",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "ANN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-874-2141"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greater Portland Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Greater Portland Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.