NPIMap

Organization Active NPI

St Croix Regional Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Calais, ME
National Provider Identifier
1467573469
Registry record updated Dec 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ST CROIX REGIONAL FAMILY HEALTH CENTER
Practice address
5 Lowell St Ste 4
Calais, ME 04619-1712
Phone
(207) 796-5503
Fax
(207) 796-5528
NPI assigned
Apr 3, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Michael Farrell, DCNPI 1962950733
Title
Ceo
Phone
(207) 796-5503

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs on the same Medicare enrollment 2

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

Other NPIs with the same Medicare PAC ID 2

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

Practitioners 21

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

Medicare participation

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

Federally qualified health center certification: CCN 201950

Medicare enrollment files
Legal name
ST CROIX REGIONAL FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 30, 2021
Last certification
Apr 30, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 30, 1991 in ME
Enrollment address
5 Lowell St
Ste 4
Calais, ME 4619

All disclosed owners & managing parties 13

Medicare enrollment files

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

NameRoleSinceShare
Angela Hanson Individual Corporate DirectorBoard Member Nov 9, 2012
Karen Sprague Individual Corporate DirectorBoard Member Nov 11, 2013
Peta Brown Individual Corporate DirectorBoard Member Nov 1, 2024
Amy McDonald Individual Corporate DirectorBoard Member Apr 12, 2022
Joanna Emery Individual Corporate DirectorBoard Member Aug 10, 2021
Karen Chesebrough Individual Corporate DirectorBoard Member Jul 9, 2019
Miriam Tippin Individual Corporate DirectorBoard Member Nov 14, 2023
John Leighton Individual Corporate DirectorBoard Member Dec 1, 2024
Michael Farrell Individual Corporate OfficerCeo Apr 22, 2024
W-2 Managing EmployeeAd; Apr 22, 2024
Scott Chesebrough Individual Corporate DirectorBoard Member Jul 9, 2019
Michael Marshall Individual Corporate DirectorBoard Member Sep 1, 2006
Nancy Marshall Individual Corporate DirectorBoard Member Nov 9, 2012
Linda Bailey Individual Corporate DirectorBoard Member Sep 1, 2006

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20041019000977 ME Part B Supplier - Clinic/Group Practice 3577524024 Receives reassigned benefits from 21 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Princeton, ME; Calais, ME
O20210511002456 ME Part a Provider - Federally Qualified Health Center (FQHC) 3577524024 Practice locations: Calais, ME

National Provider Directory

National Provider Directory

Locations

35 Blue Devil HL
Calais, ME 04619

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

NPPES NPI Registry

Primary practice location

5 Lowell St Ste 4
Calais, ME 04619-1712

Mailing address

136 Mill St
Princeton, ME 04668-3344
Phone (207) 796-5503

Other names 1

NPPES NPI Registry
  • St. Croix Regional at Calais Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 11, 2024.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733875200000",
    "number": "1467573469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 MILL ST",
            "city": "PRINCETON",
            "state": "ME",
            "postal_code": "046683344",
            "telephone_number": "207-796-5503",
            "fax_number": "207-796-5528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 LOWELL ST STE 4",
            "city": "CALAIS",
            "state": "ME",
            "postal_code": "046191712",
            "telephone_number": "207-796-5503",
            "fax_number": "207-796-5528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CROIX REGIONAL FAMILY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A",
        "authorized_official_last_name": "FARRELL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-796-5503",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Croix Regional at Calais",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "St. Croix Regional at Calais",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Calais, ME

Sources for this page

Verify at the official NPI Registry.