NPIMap

Organization Active NPI

Pines Health Services

Doing business as Washburn Health Center

  • Federally Qualified Health Center (FQHC)
  • Washburn, ME
National Provider Identifier
1922449834
Registry record updated Aug 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PINES HEALTH SERVICES
Doing business as
Washburn Health Center
Practice address
1260 Main Street
Washburn, ME 04786
Phone
(207) 455-4750
Fax
(207) 455-4729
NPI assigned
Jul 9, 2013
Last updated
Aug 27, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
PINES HEALTH SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 27, 2013

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

Authorized official

Name
Mr. James M Davis
Title
Ceo
Phone
(207) 498-2359

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU
Family Medicine Physician 207Q00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Physician Assistant 363A00000X NU
Family Nurse Practitioner 363LF0000X NU

Addresses

Primary practice location

1260 Main Street
Washburn, ME 04786

Mailing address

74 Access Hwy
Caribou, ME 04736-3807
Phone (207) 498-2359

Other names 1

  • Washburn 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
O20040823001052 ME Part B Supplier - Clinic/Group Practice 0749275113 Receives reassigned benefits from 100 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Caribou, ME; Presque Isle, ME; Van Buren, ME
O20130807000124 ME Part A Provider - Federally Qualified Health Center (FQHC) 0749275113 Practice locations: Washburn, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922449834. Details of each certification follow.

Federally qualified health center certification: CCN 201902

Legal name
PINES HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 12, 2013
Last certification
Aug 12, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 6, 1981 in ME
Enrollment address
1260 Main St
Washburn, ME 4786

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Pines Health Services7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

163 Van Buren Rd
Ste 4
Caribou, ME 04736
Phone (207) 492-3451

7 Hatch Dr
Caribou, ME 04736
Phone (207) 484-8216

6 N Carolina Rd
#B
Limestone, ME 04750
Phone (207) 328-4631

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Kristie Moir Individual Corporate Director Feb 1, 2016
Betty Hatch Individual Corporate Director Oct 1, 2010
Chelsea Desrosiers Individual Corporate Director Jan 1, 2019
Diane Gove Individual Corporate Director Feb 1, 2019
Dana Rattray Individual Corporate Director Feb 1, 2008
Tanya Sleeper Individual Corporate Director Mar 1, 2009
Mark Anderson Individual Corporate Officer Mar 1, 2024
Lisa Caron Individual Corporate Officer Nov 1, 2006
Nicole Cote Individual Corporate Officer Mar 1, 2024
Stev B Rogeski Individual Corporate Director Jan 1, 2013
Kris Doody Individual Corporate OfficerChief Executive Officer Jan 1, 2018
W-2 Managing EmployeeCeo Jan 1, 2019

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 101

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 101

NPI Registry JSON

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

{
    "created_epoch": "1373328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377561600000",
    "number": "1922449834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74 ACCESS HWY",
            "city": "CARIBOU",
            "state": "ME",
            "postal_code": "047363807",
            "telephone_number": "207-498-2359",
            "fax_number": "207-498-2352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 MAIN STREET",
            "city": "WASHBURN",
            "state": "ME",
            "postal_code": "04786",
            "telephone_number": "207-455-4750",
            "fax_number": "207-455-4729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINES HEALTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PINES HEALTH SERVICES",
        "enumeration_date": "2013-07-09",
        "last_updated": "2013-08-27",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-498-2359",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Washburn Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Washburn, ME

Sources for this page

Verify at the official NPI Registry.