NPIMap

Organization Active NPI

Mercy Hospital

  • General Acute Care Hospital
  • Portland, ME
National Provider Identifier
1629078712
Registry record updated Apr 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
36899 Issued in ME
Legal business name
MERCY HOSPITAL
Practice address
175 Fore River Pkwy
Portland, ME 04102-2779
Phone
(207) 879-3000
NPI assigned
Jul 29, 2005
Last updated
Apr 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2022

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

Authorized official

Name
Miss Theresa Marie Huck
Title
Delegated Official
Phone
(207) 879-3155

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 36899 ME Primary

Addresses

Primary practice location

175 Fore River Pkwy
Portland, ME 04102-2779

Mailing address

175 Fore River Pkwy
Portland, ME 04102-2779
Phone (207) 879-3000

Other identifiers 1

IdentifierTypeStateIssuer
101850000MedicaidME

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030804000008 ME Part A Provider - Hospital 6103737812 1 other NPI on this enrollment
Practice locations: Portland, ME; Falmouth, ME; Windham, ME; Yarmouth, ME; South Portland, ME; Gorham, ME; Waterville, ME
O20040217000943 ME Part B Supplier - Clinic/Group Practice 6103737812 Receives reassigned benefits from 466 practitioners
1 other NPI on this enrollment
Practice locations: Portland, ME; Saco, ME; South Portland, ME; Waterville, ME; Westbrook, ME; Windham, ME; Yarmouth, ME; Auburn, ME…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629078712. Details of each certification follow.

Hospital certification: CCN 200008

Legal name
MERCY HOSPITAL
Doing business as
NORTHERN LIGHT MERCY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jul 18, 2005
Beds
230
Ownership / control type
Church
Organization structure
CorporationNon-profit
Enrollment address
175 Fore River Pkwy
Portland, ME 41022779
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

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).

  • Mercy Hospital

    dba Northern Light Mercy Health Center

    • Rural Health Clinic/Center
    • Windham, ME
    • NPI 1396496378

    6103737812

    Same PAC ID

Other NPIs on the same Medicare enrollment 1

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

  • Mercy Hospital

    dba Mercy Medical Associates

    • General Acute Care Hospital
    • Portland, ME
    • NPI 1427313048

    O20030804000008, O20040217000943

    Same enrollment

Care Compare: Hospital

Medicare Care Compare
Listed as
Northern Light Mercy HospitalCCN 200008 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

75 Gray Rd
Falmouth, ME 04105
Phone (207) 525-1340

19 S Gorham Xing
#1
Gorham, ME 04038

195 Fore River Pkwy
Ste 120
Portland, ME 04102
Phone (207) 415-4841

195 Fore River Pkwy
Ste 210
Portland, ME 04102
Phone (207) 535-1150

195 Fore River Pkwy
Ste 310
Portland, ME 04102
Phone (207) 523-5901

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
David Kennedy Individual W-2 Managing EmployeeVP of Finance Aug 2, 2022
Laura L Blaisdell Individual Corporate Officer Jan 1, 2019
Ben L Russell Individual Corporate Officer Jan 1, 2019
Art Batson Individual Corporate Director Jan 1, 2019
Doug J McKeown Individual Corporate Officer Jan 1, 2019
Paul Lones Individual Corporate Officer Jan 1, 2019
Lisa Toner Individual Corporate Officer Jan 1, 2019
Anne-Marie Bourque Individual Corporate Officer Jan 1, 2019
Mary M. Morey Individual Corporate DirectorBoard Member Oct 16, 2014
Eastern Maine Healthcare Services Organization, Brewer, ME Non-profit 5% Or Greater Direct Ownership Interest Oct 1, 2013 100%
Christopher Howard Individual Corporate OfficerChairman of the Board Jul 1, 2015
Marie Vienneau Individual Corporate OfficerPresident Jan 1, 2026
Karen Pardue Individual Corporate Officer Jan 16, 2020
Mike Varney Individual Corporate Officer Jan 1, 2019
Charlie Therrien Individual Corporate OfficerPresident Nov 14, 2016 100%
Operational/Managerial ControlPresident Nov 14, 2016 100%
Debra D Taylor Individual Corporate DirectorBoard Member Oct 1, 2013
Patricia Pora Individual Corporate Officer Jan 1, 2019
William F Schirmer Individual Corporate DirectorBoard Member Apr 4, 2011
Joseph Gray Individual Corporate DirectorBoard Member Jun 1, 2010

Owners & managing parties with NPI records 1

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

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 632

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 632

Affiliated clinicians 556

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 556

NPI Registry JSON

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649980800000",
    "number": "1629078712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 FORE RIVER PKWY",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022779",
            "telephone_number": "207-879-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 FORE RIVER PKWY",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022779",
            "telephone_number": "207-879-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-29",
        "last_updated": "2022-04-15",
        "certification_date": "2022-04-15",
        "status": "A",
        "authorized_official_last_name": "HUCK",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "207-879-3155",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "ME",
            "license": "36899",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101850000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.