NPIMap

Organization Active NPI

St Croix Regional Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Princeton, ME
National Provider Identifier
1831174614
Registry record updated Mar 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ST CROIX REGIONAL FAMILY HEALTH CENTER
Practice address
136 Mill St
Princeton, ME 04668-3344
Phone
(207) 796-5503
Fax
(207) 796-5528
NPI assigned
Dec 14, 2005
Last updated
Mar 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2025

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

Authorized official

Name
Michael Farrell, DCNPI 1962950733
Title
Ceo
Phone
(207) 796-5503

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

136 Mill St
Princeton, ME 04668-3344

Mailing address

136 Mill St
Princeton, ME 04668-3344
Phone (207) 796-5503

Other identifiers 1

IdentifierTypeStateIssuer
123350000MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20041019000977 ME Part B Supplier - Clinic/Group Practice 3577524024 Receives reassigned benefits from 21 practitioners
2 other NPIs on this enrollment
Practice locations: Princeton, ME; Calais, ME
O20081024000307 ME Part A Provider - Federally Qualified Health Center (FQHC) 3577524024 Practice locations: Princeton, ME
O20250501000073 ME DME Supplier - Physician - Optometrist 3577524024 Practice locations: Princeton, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831174614. Details of each certification follow.

Federally qualified health center certification: CCN 201829

Legal name
ST CROIX REGIONAL FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 1, 1995
Last certification
Dec 1, 1995
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 30, 1991 in ME
Enrollment address
136 Mill St
Princeton, ME 46683344

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
20D0671432St Croix Regional Family Health Center136 Mill St, Princeton, ME 04668Certificate of waiverDec 31, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
St Croix Regional Family Health Cen136 Mill St, Princeton, ME 04668-3344(207) 796-5503 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Dec 4, 1991

National Provider Directory

National Provider Directory
Tax ID family
St Croix Regional Family Health Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

5 Lowell St
Ste 4
Calais, ME 04619
Phone (207) 796-5033

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Angela Hanson Individual Corporate DirectorBoard Member Nov 9, 2012
Karen Sprague Individual Corporate DirectorBoard Member Nov 11, 2013
Peta Brown Individual Corporate DirectorBoard Member Nov 1, 2024
Amy McDonald Individual Corporate DirectorBoard Member Apr 12, 2022
Joanna Emery Individual Corporate DirectorBoard Member Aug 10, 2021
Karen Chesebrough Individual Corporate DirectorBoard Member Jul 9, 2019
Gretchen Cilley Individual Corporate OfficerPatient Accounts Jun 1, 2022
W-2 Managing EmployeePatient Accounts Jun 1, 2022
Miriam Tippin Individual Corporate DirectorBoard Member Nov 14, 2023
John Leighton Individual Corporate DirectorBoard Member Dec 1, 2024
Michael Farrell Individual Corporate OfficerCeo Apr 22, 2024
W-2 Managing EmployeeAd; Apr 22, 2024
Scott Chesebrough Individual Corporate DirectorBoard Member Jul 9, 2019
Michael Marshall Individual Corporate DirectorBoard Member, Chairman Sep 1, 2006
Nancy Marshall Individual Corporate DirectorBoard Member Nov 9, 2012
Linda Bailey Individual Corporate DirectorBoard Member Sep 1, 2006

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741046400000",
    "number": "1831174614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 MILL ST",
            "city": "PRINCETON",
            "state": "ME",
            "postal_code": "046683344",
            "telephone_number": "207-796-5503",
            "fax_number": "207-796-5528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 MILL ST",
            "city": "PRINCETON",
            "state": "ME",
            "postal_code": "046683344",
            "telephone_number": "207-796-5503",
            "fax_number": "207-796-5528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CROIX REGIONAL FAMILY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-14",
        "last_updated": "2025-03-04",
        "certification_date": "2025-03-04",
        "status": "A",
        "authorized_official_last_name": "FARRELL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-796-5503",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123350000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Princeton, ME

Sources for this page

Verify at the official NPI Registry.