NPIMap

Organization Active NPI

State of Maine

Doing business as Dorothea Dix Psychiatric Center

  • Psychiatric Hospital
  • Bangor, ME
National Provider Identifier
1699776146
Registry record updated Jun 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
STATE OF MAINE
Doing business as
Dorothea Dix Psychiatric Center
Practice address
656 State St
Bangor, ME 04401-5609
Phone
(207) 941-4192
NPI assigned
Aug 9, 2005
Last updated
Jun 17, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2019

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

Authorized official

Name
Carol Webb Cody
Title
Financial Manager
Phone
(207) 941-4192

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

656 State St
Bangor, ME 04401-5609

Mailing address

109 Capitol Street
State House Station #11, Reimbursement Unit
Augusta, ME 04330-6846
Phone (207) 287-7418

Other identifiers 2

IdentifierTypeStateIssuer
135910900MedicaidME
003288OtherMEBLUE CROSS

Other names 1

  • Dorothea Dix Psychiatric Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20021017000008 ME Part A Provider - Hospital 7517875131 Practice locations: Bangor, ME
O20040610001611 ME Part B Supplier - Clinic/Group Practice 7517875131 Receives reassigned benefits from 99 practitioners
3 other NPIs on this enrollment
Practice locations: Augusta, ME; Bangor, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699776146. Details of each certification follow.

Hospital certification: CCN 204004

Legal name
STATE OF MAINE
Doing business as
DOROTHEA DIX PSYCHIATRIC CENTER
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Nov 7, 1983
Last certification
May 20, 2009
Beds
100
Ownership / control type
Local
Organization structure
OtherNon-profit
Enrollment address
656 State St, State of Maine
Bangor, ME 44020926
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric

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 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Dorothea Dix Psychiatric CenterCCN 204004 · All quality measures
Type
Psychiatric
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory

Locations

109 Capitol St
Augusta, ME 04333

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Carolyn Dimek Individual Corporate Officer Nov 3, 2018
Corporate Director Nov 3, 2018
W-2 Managing Employee Nov 3, 2018
State of Maine Organization, Bangor, ME Non-profit Operational/Managerial Control Nov 3, 2018 100%

Owners & managing parties with NPI records 1

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

  • State of Maine

    dba Riverview Psychiatric Hospital

    • Psychiatric Hospital
    • Augusta, ME
    • NPI 1053319566

    Operational/Managerial Control

    CMS ownership

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Riverview Psychiatric CenterAugusta, ME, CCN 204008 Hospital 5% Or Greater Direct Ownership Interest (1%)
5% Or Greater Indirect Ownership Interest (1%)
Operational/Managerial Control (1%)		 Jan 1, 2023
Jan 1, 2023
Sep 8, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • State of Maine

    dba Riverview Psychiatric Hospital

    • Psychiatric Hospital
    • Augusta, ME
    • NPI 1053319566

    5% Or Greater Direct Ownership Interest, 5% Or Greater Indirect Ownership Interest, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 104

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 104

NPI Registry JSON

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560729600000",
    "number": "1699776146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 CAPITOL STREET",
            "address_2": "STATE HOUSE STATION #11, REIMBURSEMENT UNIT",
            "city": "AUGUSTA",
            "state": "ME",
            "postal_code": "043306846",
            "telephone_number": "207-287-7418",
            "fax_number": "207-287-1862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "656 STATE ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044015609",
            "telephone_number": "207-941-4192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MAINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2019-06-17",
        "status": "A",
        "authorized_official_last_name": "CODY",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "WEBB",
        "authorized_official_title_or_position": "FINANCIAL MANAGER",
        "authorized_official_telephone_number": "207-941-4192"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135910900",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "003288",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dorothea Dix Psychiatric Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dorothea Dix Psychiatric Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.