Eastport Memorial Hospital

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

36544 Issued in ME

Legal business name

EASTPORT MEMORIAL HOSPITAL

Doing business as

Eastport Memorial Nursing Home

Practice address

23 Boynton Street
Eastport, ME 04628-1304

Phone

(207) 853-2531

Fax

(207) 853-7117

NPI assigned

Sep 15, 2006

Last updated

Jul 27, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. John Erlen Wood

Title

Administrator

Phone

(207) 853-2531

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Eastport Memorial Nursing Home Doing business as

Medicare fee-for-service enrollment

Enrolled in ME

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912003328. Details of each certification follow.

• CCN 205146 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 205146

Legal name

EASTPORT MEMORIAL HOSPITAL

Doing business as

EASTPORT MEMORIAL NURSING HOME

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Mar 1, 1994

Last certification

Jan 29, 2025

Beds

26

Ownership / control type

Nonprofit Corporation

Organization structure

CorporationNon-profit

Incorporated

Feb 23, 1944 in ME

Enrollment address

23 Boynton Street
Eastport, ME 04631-1304

Nursing home name

EASTPORT MEMORIAL NURSING HOME

Listed as

Eastport Memorial Nursing HomeCCN 205146 · All quality measures

Overall star rating

2 of 5

Health inspections

2 of 5

Staffing

4 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

Mar 1, 1994

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

2624.3 residents per day on average

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 13

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

Owners & managing parties with NPI records 1

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

• Peter Scott Wilkinson, D.O.

  • Internal Medicine Physician
  • Calais, ME
  • NPI 1578594818

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Practitioners 5

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.

• Kristen L Barbee, D.O.

  • Family Medicine Physician
  • Saco, ME
  • NPI 1215166533
  NPD
• John F Cassidy IV, PA-C

  • Physician Assistant
  • Eastport, ME
  • NPI 1891890166
  NPD (past)
• Laurie A Churchill, MD

  • Family Medicine Physician
  • Calais, ME
  • NPI 1962463224
  NPD (past)
• Susan L. Luthin, M.D.

  • Family Medicine Physician
  • Dover Foxcroft, ME
  • NPI 1356383962
  NPD (past)
• William B Richardson, MD

  • Family Medicine Physician
  • Eastport, ME
  • NPI 1457409617
  NPD (past)

Affiliated clinicians 2

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

• John F Cassidy IV, PA-C

  • Physician Assistant
  • Eastport, ME
  • NPI 1891890166

  Nursing home

  Care Compare affiliation
• William B Richardson, MD

  • Family Medicine Physician
  • Eastport, ME
  • NPI 1457409617

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658880000000",
    "number": "1912003328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 BOYNTON STREET",
            "city": "EASTPORT",
            "state": "ME",
            "postal_code": "046281304",
            "telephone_number": "207-853-2531",
            "fax_number": "207-853-7117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 BOYNTON STREET",
            "city": "EASTPORT",
            "state": "ME",
            "postal_code": "046281304",
            "telephone_number": "207-853-2531",
            "fax_number": "207-853-7117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTPORT MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ERLEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "207-853-2531",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ME",
            "license": "36544",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102120000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastport Memorial Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Joy Doucette, PMHNP
• Susan Marie Drew, RDH
• Kathleen M Dunbar, RDH
• Eastport Family Pharmacy
• Eastport Health Care, Inc.
• Eastport School Department
• Abhay Arun Ektare
• Kendall Community Case Management Agency
• Pamela J. Koenig, MSN, CRNP
• Anne M Leaver, LCPC

• Skilled Nursing Facility in Eastport, ME
• Providers in Eastport, ME by specialty
• Skilled Nursing Facility in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.