NPIMap

Organization Active NPI

Portland Community Health Center

Doing business as Greater Portland Health

  • Federally Qualified Health Center (FQHC)
  • South Portland, ME
National Provider Identifier
1689352494
Registry record updated Jul 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PORTLAND COMMUNITY HEALTH CENTER
Doing business as
Greater Portland Health
Practice address
120 Wescott Rd
South Portland, ME 04106-3420
Phone
(207) 874-2141
Fax
(207) 874-2164
NPI assigned
Jul 11, 2023
Last updated
Jul 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2023

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

Authorized official

Name
Ann F Tucker
Title
Ceo
Phone
(207) 874-2141

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

120 Wescott Rd
South Portland, ME 04106-3420

Mailing address

180 Park Ave
Portland, ME 04102-2957
Phone (207) 874-2141

Other names 1

  • Greater Portland Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231025000831 ME Part A Provider - Federally Qualified Health Center (FQHC) 5395998017 Practice locations: South Portland, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689352494. Details of each certification follow.

Federally qualified health center certification: CCN 201031

Legal name
PORTLAND COMMUNITY HEALTH CENTER
Doing business as
GREATER PORTLAND HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 24, 2023
Last certification
Oct 24, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 30, 2013 in ME
Enrollment address
120 Wescott Rd
South Portland, ME 41063420

Other NPIs with the same Medicare PAC ID 17

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

View all 17

National Provider Directory

National Provider Directory
Tax ID family
Portland Community Health Center43 organizations share this tax ID, including this one

Other organizations with this tax ID 42

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

View all 42

Locations

120 Wescott Rd
South Portland, ME 04106

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
Axel Nimbona Individual Corporate DirectorBoard Member Apr 16, 2024
Ann Tucker Individual Corporate OfficerCeo Apr 4, 2018
W-2 Managing EmployeeCeo Apr 4, 2018
Paul Santomenna Individual Corporate DirectorPresident Dec 26, 2017
Belviga Mpolo Individual Corporate DirectorBoard Member Jan 27, 2026
Christine Caulfield Individual Corporate DirectorVice President Jan 24, 2023
Connor O'Neill Individual Corporate DirectorBoard Member Apr 16, 2024
Christopher Dana Individual Corporate DirectorSecretary Jul 27, 2021
Isaac Macdougal Individual Corporate DirectorBoard Member Apr 16, 2024
Marie a Guay Individual Corporate DirectorBoard Member Apr 16, 2024
Richard M White Individual Corporate DirectorTreasurer Jan 24, 2017
Doreen Karigirwa Individual Corporate DirectorBoard Member Jan 27, 2026
John Dearmond Individual Corporate DirectorBoard Member Jan 27, 2026

NPI Registry JSON

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

{
    "created_epoch": "1689033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689033600000",
    "number": "1689352494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 PARK AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022957",
            "telephone_number": "207-874-2141",
            "fax_number": "207-874-2164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 WESCOTT RD",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041063420",
            "telephone_number": "207-874-2141",
            "fax_number": "207-874-2164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-11",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-05",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "ANN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-874-2141"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greater Portland Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Portland, ME

Sources for this page

Verify at the official NPI Registry.