NPIMap

Organization Active NPI

Maine Coast Regional Health Facilities

Doing business as Maine Coast Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Ellsworth, ME
National Provider Identifier
1447204763
Registry record updated Sep 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
36279 Issued in ME
Legal business name
MAINE COAST REGIONAL HEALTH FACILITIES
Doing business as
Maine Coast Memorial Hospital
Northern Light Maine Coast Hospital
Practice address
50 Union St
Ellsworth, ME 04605-1586
Phone
(207) 664-5301
Fax
(207) 664-5498
NPI assigned
May 20, 2006
Last updated
Sep 25, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
MAINE COAST REGIONAL HEALTH FACILITIESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 25, 2018

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

Authorized official

Name
Mr. John Ronan
Title
President
Phone
(207) 664-5311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 36279 ME Primary

Addresses

Primary practice location

50 Union St
Ellsworth, ME 04605-1586

Mailing address

50 Union St
Ellsworth, ME 04605-1586

Other names 2

  • Maine Coast Memorial Hospital Doing business as
  • Northern Light Maine Coast Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040804001405 ME Part B Supplier - Clinic/Group Practice 1052208113 Receives reassigned benefits from 205 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Southwest Harbor, ME; Gouldsboro, ME; Ellsworth, ME
O20071101000186 ME Part A Provider - Hospital 1052208113 Practice locations: Ellsworth, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447204763. Details of each certification follow.

Hospital certification: CCN 20U050

Legal name
MAINE COAST REGIONAL HEALTH FACILITIES
Doing business as
NORTHERN LIGHT MAINE COAST HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Apr 24, 1947 in ME
Enrollment address
50 Union St
Ellsworth, ME 46051586
Other Hospital Practice Location
Hospital subgroups
General, Swing-bed approved

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).

Other NPIs on the same Medicare enrollment 2

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

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
20D0089815Maine Coast Memorial Hospital50 Union St, Ellsworth, ME 04605AccreditationJan 2, 2027

National Provider Directory

National Provider Directory
Part of
Maine Coast Mem Hosp FP

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Kevin Tesseo Individual Corporate Director Sep 27, 2011
Sally J Hutchins Individual Corporate Director Sep 24, 2013
Jeffrey Dow Individual Corporate Director Sep 27, 2011
Alan H Nauss Individual Corporate Director Sep 27, 2011
Adin Tooker Individual Corporate Director Oct 12, 2007
Scott Kimball Individual Corporate Director Sep 27, 2011
Debra Ehrlenbach Individual Corporate Director Sep 27, 2011
Wendy J Merchant Individual Corporate OfficerVice President of Finance Apr 3, 2017
W-2 Managing EmployeeVice President of Finance Apr 3, 2017
Eastern Maine Healthcare Services Organization, Brewer, ME Corporation, Non-profit Operational/Managerial Control Oct 1, 2015
Glenn Martin Individual Corporate DirectorBoard Member Oct 1, 2015
Michelle M Hood Individual Corporate DirectorBoard Member Oct 1, 2015
Curtis Simard Individual Corporate DirectorBoard Member Oct 1, 2015
John Ronan Individual Corporate DirectorPresident Nov 14, 2016
W-2 Managing EmployeePresident Nov 14, 2016
Maine Coast Healthcare Corporation Organization, Ellsworth, ME Corporation, Non-profit Operational/Managerial Control Oct 1, 2015
Karen Stanley Individual Corporate Director Oct 12, 2007
Scott S Hammond Individual Corporate Director Sep 24, 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 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537833600000",
    "number": "1447204763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 UNION ST",
            "city": "ELLSWORTH",
            "state": "ME",
            "postal_code": "046051586",
            "fax_number": "207-664-5498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 UNION ST",
            "city": "ELLSWORTH",
            "state": "ME",
            "postal_code": "046051586",
            "telephone_number": "207-664-5301",
            "fax_number": "207-664-5498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINE COAST REGIONAL HEALTH FACILITIES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MAINE COAST REGIONAL HEALTH FACILITIES",
        "enumeration_date": "2006-05-20",
        "last_updated": "2018-09-25",
        "status": "A",
        "authorized_official_last_name": "RONAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "207-664-5311",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "ME",
            "license": "36279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maine Coast Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northern Light Maine Coast Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ellsworth, ME

Sources for this page

Verify at the official NPI Registry.