NPIMap

Organization Active NPI

Penobscot Community Health Center

Doing business as Capehart Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Bangor, ME
National Provider Identifier
1740373679
Registry record updated Aug 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PENOBSCOT COMMUNITY HEALTH CENTER
Doing business as
Capehart Community Health Center
Practice address
86 Davis Rd
Bangor, ME 04401
Phone
(207) 992-2205
Fax
(207) 992-2207
NPI assigned
Oct 2, 2006
Last updated
Aug 6, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
PENOBSCOT COMMUNITY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 6, 2018

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

Authorized official

Name
Lori L. Dwyer, ESQ.
Title
President & Ceo
Phone
(207) 992-9200

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

86 Davis Rd
Bangor, ME 04401

Mailing address

PO Box 1599
103 Maine Ave
Bangor, ME 04402-1599
Phone (207) 945-5247

Other identifiers 2

IdentifierTypeStateIssuer
131160200MedicaidME
MM9086OtherMEDICARE GROUP

Other names 1

  • Capehart Community Health 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
O20040819000698 ME Part B Supplier - Clinic/Group Practice 0143212670 Receives reassigned benefits from 154 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jackman, ME; Old Town, ME; Brewer, ME; Belfast, ME; Bangor, ME
O20080418000295 ME Part A Provider - Federally Qualified Health Center (FQHC) 0143212670 Practice locations: Bangor, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740373679. Details of each certification follow.

Federally qualified health center certification: CCN 201882

Legal name
PENOBSCOT COMMUNITY HEALTH CENTER
Doing business as
CAPEHART COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 25, 2008
Last certification
Apr 25, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 1, 2006 in ME
Enrollment address
86 Davis Rd
Bangor, ME 44012311

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory
Part of
Manna Inc

Locations

576 Stillwater Ave
Old Town, ME 04468
Phone (207) 404-8000

775 N Main St
Winterport, ME 04496
Phone (207) 223-0965

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Christopher Linder Individual Corporate Director Oct 1, 2020
Mark Doty Individual Corporate Director Apr 25, 2008
Shelly Okere Individual Corporate Director Oct 1, 2020
Aaron Ballman Individual Corporate Director Sep 1, 2015
Mary Ellen Dunfield Individual Corporate Director Apr 5, 2022
Daniel Frye Individual Corporate Director Apr 5, 2022
Kelley Strout Individual Corporate Director Nov 1, 2017
Edwin Goodwin Individual Corporate Director Dec 7, 2021
Alan Duplessis Individual Corporate Director Dec 1, 2013
Katie Spencer White Individual Corporate Director Nov 2, 2021
Christopher Winstead Individual Corporate Director Oct 1, 2012
Christine Finn-McLaughlin Individual Corporate Officer Feb 3, 2015
Corporate Director Feb 3, 2015
W-2 Managing Employee Feb 3, 2015
Carin Sychterz Individual Corporate Director Apr 1, 2016
Jennifer Eastman Individual Corporate Director Apr 25, 2008
Monique Gauteau Individual Corporate Director Sep 1, 1997
Lorelle L Dwyer Individual Corporate Officer Sep 1, 2017
Corporate Director Sep 1, 2017
W-2 Managing Employee Sep 1, 2017
Robert Paul Allen Individual Corporate Director May 1, 2016
Mark Woodward Individual Corporate Director Apr 25, 2008

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533513600000",
    "number": "1740373679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1599",
            "address_2": "103 MAINE AVE",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021599",
            "telephone_number": "207-945-5247",
            "fax_number": "207-992-2154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 DAVIS RD",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "04401",
            "telephone_number": "207-992-2205",
            "fax_number": "207-992-2207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENOBSCOT COMMUNITY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENOBSCOT COMMUNITY HEALTH CENTER",
        "enumeration_date": "2006-10-02",
        "last_updated": "2018-08-06",
        "status": "A",
        "authorized_official_last_name": "DWYER",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "207-992-9200",
        "authorized_official_credential": "ESQ."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "131160200",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "MM9086",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Capehart Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.