NPIMap

Organization Active NPI

Penobscot Community Health Center

Doing business as Penobscot Community Health Care

  • Federally Qualified Health Center (FQHC)
  • Bangor, ME
National Provider Identifier
1427169010
Registry record updated Aug 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PENOBSCOT COMMUNITY HEALTH CENTER
Doing business as
Penobscot Community Health Care
Practice address
1012 Union St
Bangor, ME 04401
Phone
(207) 945-5247
Fax
(207) 907-7079
NPI assigned
Aug 31, 2006
Last updated
Aug 6, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2018

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

Authorized official

Name
Lori L. Dwyer, ESQ.
Title
Ceo and President
Phone
(207) 404-8200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1012 Union St
Bangor, ME 04401

Mailing address

PO Box 1599
Bangor, ME 04402-1599
Phone (207) 945-5247

Other identifiers 2

IdentifierTypeStateIssuer
131160100MedicaidME
131160200MedicaidME

Other names 1

  • Penobscot Community Health Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20040402000293 ME Part A Provider - Federally Qualified Health Center (FQHC) 0143212670 Practice locations: Bangor, ME
O20040819000698 ME Part B Supplier - Clinic/Group Practice 0143212670 Receives reassigned benefits from 154 practitioners
18 other NPIs on this enrollment
Practice locations: Jackman, ME; Old Town, ME; Brewer, ME; Belfast, ME; Bangor, ME
O20160711001550 ME Part B Supplier - Mass Immunization (Roster Biller Only) 0143212670 4 other NPIs on this enrollment
Practice locations: Old Town, ME; Belfast, ME; Bangor, ME; Brewer, ME
O20180228001877 ME DME Supplier - Pharmacy 0143212670 Practice locations: Bangor, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1427169010. Details of each certification follow.

Federally qualified health center certification: CCN 201832

Legal name
PENOBSCOT COMMUNITY HEALTH CENTER
Doing business as
PENOBSCOT COMMUNITY HEALTH CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 23, 2000
Last certification
Jun 23, 2000
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Sep 4, 1997 in ME
Enrollment address
1012 Union St
Bangor, ME 44013060

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

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Other NPIs on the same Medicare enrollment 20

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

View all 20

National Provider Directory

National Provider Directory

Locations

1012 Union St
Ste 3
Bangor, ME 04401
Phone (207) 404-8040

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Christopher Linder Individual Corporate Director Oct 1, 2020
Shelly Okere Individual Corporate Director Oct 1, 2020
Aaron Ballman Individual Corporate DirectorDirector Sep 1, 2015
Mary Ellen Dunfield Individual Corporate Director Apr 5, 2022
Daniel Williams Individual Corporate Director Mar 1, 2020
Daniel Frye Individual Corporate Director Apr 5, 2022
Kelley Strout Individual Corporate DirectorDirector Nov 1, 2017
Edwin Goodwin Individual Corporate Director Dec 7, 2021
Alan Duplessis Individual Corporate DirectorDirector Dec 1, 2013
Katie Spencer White Individual Corporate Director Nov 2, 2021
Christopher Winstead Individual Corporate Director Oct 1, 2012
Christine Finn-McLaughlin Individual Corporate OfficerChief Financial Officer Feb 3, 2015
Operational/Managerial ControlChief Financial Officer Feb 3, 2015
Carin Sychterz Individual Corporate DirectorDirector Apr 1, 2016
Jennifer Eastman Individual Corporate Director Dec 1, 2009
Monique Gauteau Individual Corporate Officer Sep 1, 2007
Lorelle L Dwyer Individual Corporate OfficerPresident Sep 1, 2017 100%
W-2 Managing EmployeeChief Executive Officer Sep 1, 2017 100%
Operational/Managerial ControlChief Executive Officer, President Sep 1, 2017 100%
Robert Paul Allen Individual Corporate DirectorDirector May 16, 2016

Practitioners & affiliated clinicians

Practitioners 160

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 160

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533513600000",
    "number": "1427169010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1599",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021599",
            "telephone_number": "207-945-5247",
            "fax_number": "207-947-0435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 UNION ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "04401",
            "telephone_number": "207-945-5247",
            "fax_number": "207-907-7079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENOBSCOT COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2018-08-06",
        "status": "A",
        "authorized_official_last_name": "DWYER",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO AND PRESIDENT",
        "authorized_official_telephone_number": "207-404-8200",
        "authorized_official_credential": "ESQ."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "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": "131160100",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "131160200",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Penobscot Community Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.