NPIMap

Organization Active NPI

Eastern Maine Medical Center

  • General Acute Care Hospital
  • Bangor, ME
National Provider Identifier
1790789147
Registry record updated Jul 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
35999 Issued in ME
Legal business name
EASTERN MAINE MEDICAL CENTER
Practice address
489 State St
Bangor, ME 04401-6616
Phone
(207) 973-7000
NPI assigned
Jun 13, 2005
Last updated
Jul 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2020

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

Authorized official

Name
Marc Edelman
Title
Sr. VP of Operations
Phone
(207) 973-8992

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 35999 ME Primary

Addresses

Primary practice location

489 State St
Bangor, ME 04401-6616

Mailing address

489 State St
Bangor, ME 04401-6616

Other identifiers 1

IdentifierTypeStateIssuer
101780000MedicaidME

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040128000088 ME Part B Supplier - Clinic/Group Practice 2062315161 Receives reassigned benefits from 883 practitioners
Practice locations: Waterville, ME; Orono, ME; Hampden, ME; Ellsworth, ME; Brewer, ME; Bangor, ME
O20060928000049 ME Part A Provider - Hospital 2062315161

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790789147. Details of each certification follow.

Hospital certification: CCN 200033

Legal name
EASTERN MAINE MEDICAL CENTER
Doing business as
NORTHERN LIGHT EASTERN MAINE MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Mar 9, 2018
Beds
411
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
489 State St
Bangor, ME 44016616
Main/Primary Hospital Location
Hospital subgroups
General, Rehabilitation unit

Care Compare: Hospital

Medicare Care Compare
Listed as
Northern Light Eastern Maine Medical CenterCCN 200033 · All quality measures
Overall star rating
5 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member organizations 10

Organizations listed as members of this organization in the National Provider Directory.

Locations (25 of 70)

20045 N 19th Ave
Ste 165
Phoenix, AZ 85027
Phone (623) 404-3115

133 Corporate Dr
Fl 2
Bangor, ME 04401
Phone (207) 275-4251

234 State St
Bangor, ME 04401

302 Husson Ave
Ste 1
Bangor, ME 04401
Phone (207) 947-6141

302 Husson Ave
Ste 2
Bangor, ME 04401
Phone (207) 941-2373

335 Stillwater Ave
Bangor, ME 04401
Phone (207) 947-1111

417 State St
Bangor, ME 04401
Phone (207) 942-6096

417 State St
Bldg W
Bangor, ME 04401

417 State St
Ste 201
Bangor, ME 04401

417 State St
Ste 221
Bangor, ME 04401
Phone (207) 973-8865

417 State St
Ste 250
Bangor, ME 04401

417 State St
Ste 280
Bangor, ME 04401

417 State St
Ste 305310
Bangor, ME 04401

417 State St
Ste 310
Bangor, ME 04401
Phone (207) 973-8327

417 State St
Ste 320
Bangor, ME 04401

417 State St
Ste 340
Bangor, ME 04401
Phone (207) 973-4949

417 State St
Ste 420
Bangor, ME 04401
Phone (207) 942-2000

417 State St
Ste 44
Bangor, ME 04401

489 State St
#3
Bangor, ME 04401

489 State St
#5
Bangor, ME 04401

489 State St
#6
Bangor, ME 04401
Phone (207) 973-6676

489 State St
#8
Bangor, ME 04401
Phone (207) 973-8955

489 State St
#G2
Bangor, ME 04401

489 State St
#G6
Bangor, ME 04401

489 State St
#G8
Bangor, ME 04401

Ownership & related parties

All disclosed owners & managing parties 23

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

NameRoleSinceShare
Lynne a Spooner Individual Corporate Director Jan 27, 2016
Jennifer Goodrich Individual Contracted Managing EmployeeInterim VP Finance Apr 15, 2026
Heather E Furth Individual Corporate Director Jan 23, 2019
Alan Jansujwicz Individual Corporate Director Jan 22, 2025
Ava Collins Individual Contracted Managing EmployeePresident Oct 13, 2024
Corporate Director Oct 13, 2024
Deborah M Sanford Individual W-2 Managing EmployeeVP, Nursing & Patient Care Services Jan 11, 2015
Eastern Maine Healthcare Services Organization, Brewer, ME Corporation Other Dec 15, 2004
Carolyn M Fetha Individual W-2 Managing EmployeeVP of Physician Services Aug 7, 2022
Lisa M Billings-Lindsey Individual Corporate Director Oct 26, 2025
Eric R Hafener Individual Contracted Managing EmployeeVP Compliance & Privacy Nov 2, 2025
Noah G Lundy Individual Contracted Managing EmployeeVP Human Resources Jan 13, 2025
Emily Ann Cain Individual Corporate Director Jan 21, 2026
Michael C McGoldrick Individual Corporate Director Jul 24, 2017
Nathaniel S Putnam Individual Corporate Director Jan 22, 2025
Bob Ziegelaar Individual Corporate DirectorBoard Member Jan 28, 2015
Jenifer L Butler Individual Corporate Director Jan 27, 2021
Angela C Fochesato Individual Corporate Director Jan 26, 2022
Reuben Guy Hudson Individual Corporate Director Nov 19, 2025
Susan C Hammond Individual Corporate Director Jan 27, 2021
Sean J Barnett Individual Corporate Director Oct 1, 2023
John I Simpson Individual Corporate Director Jan 27, 2016
Brien C Walton Individual Corporate Director Jan 24, 2024
Charles a Staley Individual W-2 Managing EmployeeIntermin Chief Medical Officer May 1, 2026

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
LTC LLCBangor, ME, CCN 205064 Skilled nursing facility 5% Or Greater Direct Ownership Interest (50%)
Adp of the SNF		 Sep 25, 2018
Sep 25, 2018
Maine Medical PartnersDexter, ME, CCN 205115 Skilled nursing facility 5% Or Greater Direct Ownership Interest (50%)
Adp of the SNF		 Oct 1, 2018
Oct 1, 2018
Katahdin Health Care LLCMillinocket, ME, CCN 205149 Skilled nursing facility 5% Or Greater Direct Ownership Interest (50%) Oct 1, 2018
Stillwater Healthcare LLCBangor, ME, CCN 205116 Skilled nursing facility 5% Or Greater Direct Ownership Interest (50%)
Adp of the SNF		 Oct 1, 2018
Oct 1, 2018
Hibbard Skilled Nursing CenterDover Foxcroft, ME, CCN 205004 Skilled nursing facility 5% Or Greater Direct Ownership Interest (50%)
Adp of the SNF
Direct Ownership Interest (50%)		 Jan 1, 2019
Jan 1, 2019
Jan 1, 2019

Owned or controlled facilities with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 1,149

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 1,149

Affiliated clinicians 1,088

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

View all 1,088

NPI Registry JSON

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595980800000",
    "number": "1790789147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "489 STATE ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "489 STATE ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016616",
            "telephone_number": "207-973-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN MAINE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-13",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A",
        "authorized_official_last_name": "EDELMAN",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "SR. VP OF OPERATIONS",
        "authorized_official_telephone_number": "207-973-8992"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "ME",
            "license": "35999",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101780000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.