NPIMap

Organization Active NPI

Northern Maine Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Fort Kent, ME
National Provider Identifier
1891184172
Registry record updated Sep 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
NORTHERN MAINE MEDICAL CENTER
Practice address
194 E Main St
Fort Kent, ME 04743-1428
Phone
(207) 834-3155
Fax
(207) 834-1410
NPI assigned
Jan 9, 2015
Last updated
Sep 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2022

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

Authorized official

Name
Mr. Jeffrey Zewe
Title
Ceo
Phone
(207) 834-1411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X ME Primary

Addresses

Primary practice location

194 E Main St
Fort Kent, ME 04743-1428

Mailing address

194 E Main St
Fort Kent, ME 04743-1428
Phone (207) 834-3155

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241205000505 ME Part A Provider - Critical Access Hospital 8426952987 Practice locations: Fort Kent, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891184172. Details of each certification follow.

Hospital certification: CCN 20Z317

Legal name
NORTHERN MAINE MEDICAL CENTER
Organization structure
CorporationNon-profit
Enrollment address
194 E Main St
Fort Kent, ME 47431428
Hospital Swing-Bed Unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory

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
Gisele Dionne Individual Corporate DirectorBoard Member Jan 30, 2019
Lucie Tabor Individual Corporate DirectorBoard Member Jan 15, 2021
Daniel Vaillancourt Individual Corporate DirectorBoard Member Jan 1, 2020
John Ezzy Individual Corporate DirectorBoard Member Jan 1, 2022
Steven Ouellette Individual Corporate DirectorBoard Member Jan 15, 2021
Jeffrey Zewe Individual Corporate OfficerCeo May 1, 2022
W-2 Managing EmployeeCeo May 1, 2022
Aaron Teachout Individual Corporate OfficerCfo Sep 30, 2021
W-2 Managing EmployeeCfo Sep 30, 2021
Norman L Fournier Individual Corporate DirectorBoard Member Jan 15, 2021
Donald Guimond Individual Corporate DirectorBoard Member/Chair Jul 21, 2015
Erin Soucy Individual Corporate DirectorBoard Member/Vice Chair Jun 28, 2016
Douglas Cyr Individual Corporate DirectorBoard Member Jan 1, 2020
Alain Bois Individual Corporate OfficerCoo Mar 29, 2021
W-2 Managing EmployeeCoo Mar 29, 2021
James V Harris Individual Corporate DirectorBoard Member Jun 20, 2023
Steven Pelletier Individual Corporate DirectorBoard Member Jan 1, 2018

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 4

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.

Affiliated clinicians 6

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

NPI Registry JSON

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

{
    "created_epoch": "1420761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663200000000",
    "number": "1891184172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "194 E MAIN ST",
            "city": "FORT KENT",
            "state": "ME",
            "postal_code": "047431428",
            "telephone_number": "207-834-3155",
            "fax_number": "207-834-1410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "194 E MAIN ST",
            "city": "FORT KENT",
            "state": "ME",
            "postal_code": "047431428",
            "telephone_number": "207-834-3155",
            "fax_number": "207-834-1410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN MAINE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-09",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-15",
        "status": "A",
        "authorized_official_last_name": "ZEWE",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-834-1411",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "ME",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Kent, ME

Sources for this page

Verify at the official NPI Registry.