NPIMap

Organization Active NPI

Katahdin Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Dover Foxcroft, ME
National Provider Identifier
1609577634
Registry record updated Mar 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
KATAHDIN VALLEY HEALTH CENTER
Practice address
188 Summer St
Dover Foxcroft, ME 04426-1129
Phone
(207) 528-2285
Fax
(207) 528-2880
NPI assigned
Mar 16, 2023
Last updated
Mar 16, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2023

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

Authorized official

Name
Claudette G Humphrey
Title
Ceo
Phone
(207) 528-2285

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

188 Summer St
Dover Foxcroft, ME 04426-1129

Mailing address

529 S Patten Rd
Patten, ME 04765-3007
Phone (207) 528-2285

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20041130000688 ME Part B Supplier - Clinic/Group Practice 4880659903 Receives reassigned benefits from 82 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ashland, ME; Patten, ME; Millinocket, ME; Lincoln, ME; Houlton, ME; Dover Foxcroft, ME; Brownville, ME
O20231214002450 ME Part A Provider - Federally Qualified Health Center (FQHC) 4880659903 Practice locations: Dover Foxcroft, ME
O20250110001628 ME DME Supplier - Physician - Optometrist 4880659903 Practice locations: Dover Foxcroft, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609577634. Details of each certification follow.

Federally qualified health center certification: CCN 201033

Legal name
KATAHDIN VALLEY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 9, 2024
Last certification
Feb 9, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 12, 1974 in ME
Enrollment address
188 Summer St
Dover Foxcroft, ME 44261129

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory
Tax ID family
Katahdin Valley Health Center15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Locations

59 Bangor St
Houlton, ME 04730
Phone (207) 532-7161

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
Rhonda R Brophy Individual Corporate DirectorBoard Member Feb 17, 2010
Brandi Stevenson Individual Corporate DirectorBoard Member Nov 17, 2021
Kathy White Individual Corporate DirectorBoard Member Nov 23, 2022
Jason Parent Individual Corporate DirectorBoard Member Oct 27, 2021
Chris M Nickerson Individual Corporate DirectorBoard Member May 25, 2008
Alicia Stone Individual Corporate DirectorBoard Member Oct 27, 2021
John Arthur Doe Individual Corporate DirectorBoard Member Mar 30, 2005
Raye Porter Individual Corporate OfficerCfo Aug 6, 2018
W-2 Managing EmployeeCfo Aug 6, 2018
Chad R Perkins Individual Corporate DirectorBoard Member Apr 27, 2016
Charity Rudge Individual Corporate OfficerBilling Manager Dec 1, 2020
W-2 Managing EmployeeBilling Manager Dec 1, 2020
Kathleen P Case Individual Corporate DirectorBoard Member Jan 29, 2014
Claudette G Humphrey Individual Corporate OfficerCeo Jul 31, 2016
W-2 Managing EmployeeCeo Jul 31, 2016

Practitioners & affiliated clinicians

Practitioners 7

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": "1678924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678924800000",
    "number": "1609577634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "529 S PATTEN RD",
            "city": "PATTEN",
            "state": "ME",
            "postal_code": "047653007",
            "telephone_number": "207-528-2285",
            "fax_number": "207-528-2880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188 SUMMER ST",
            "city": "DOVER FOXCROFT",
            "state": "ME",
            "postal_code": "044261129",
            "telephone_number": "207-528-2285",
            "fax_number": "207-528-2880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATAHDIN VALLEY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-16",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-13",
        "status": "A",
        "authorized_official_last_name": "HUMPHREY",
        "authorized_official_first_name": "CLAUDETTE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-528-2285"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dover Foxcroft, ME

Sources for this page

Verify at the official NPI Registry.