NPIMap

Organization Active NPI

Pines Health Services

  • Internal Medicine Physician
  • Caribou, ME
National Provider Identifier
1942277819
Registry record updated Jan 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PINES HEALTH SERVICES
Practice address
74 Access Hwy
Caribou, ME 04736
Phone
(207) 498-2350
Fax
(207) 498-2352
NPI assigned
Mar 1, 2006
Last updated
Jan 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2021

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

Authorized official

Name
Lisa Caron
Title
Coo
Phone
(207) 498-2356

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Midwife 176B00000X
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X Primary
Obstetrics & Gynecology Physician 207V00000X
Ophthalmology Physician 207W00000X
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X
Pediatrics Physician 208000000X
Surgery Physician 208600000X
Vascular Surgery Physician 2086S0129X
Urology Physician 208800000X
Hospitalist Physician 208M00000X
Foot & Ankle Surgery Podiatrist 213ES0103X
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X
Pediatric Orthopaedic Surgery Physician 207XP3100X

Addresses

Primary practice location

74 Access Hwy
Caribou, ME 04736

Mailing address

PO Box 40
Caribou, ME 04736
Phone (207) 498-2350

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME5 enrollments

Enrollment records 5

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
Practice locations: Caribou, ME; Presque Isle, ME; Van Buren, ME
O20070711000829 ME Part A Provider - Federally Qualified Health Center (FQHC) 0749275113 Practice locations: Caribou, ME
O20070711000834 ME Part A Provider - Federally Qualified Health Center (FQHC) 0749275113 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Presque Isle, ME
O20070716000498 ME Part A Provider - Federally Qualified Health Center (FQHC) 0749275113 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Van Buren, ME
O20070716000503 ME Part A Provider - Federally Qualified Health Center (FQHC) 0749275113 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Caribou, ME

NPI to CCN mapping 4

The Medicare certification numbers (CCNs) connected to NPI 1942277819. Details of each certification follow.

Federally qualified health center certification: CCN 201868

Legal name
PINES HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 20, 2007
Last certification
Aug 20, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 7, 1981 in ME
Enrollment address
74 Access Highway
Caribou, ME 47363807

Federally qualified health center certification: CCN 201869

Legal name
PINES HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 20, 2007
Last certification
Aug 20, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 7, 1981 in ME
Enrollment address
66 Spruce St Ste 4
Presque Isle, ME 47693243

Federally qualified health center certification: CCN 201866

Legal name
PINES HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 27, 2007
Last certification
Aug 27, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 7, 1981 in ME
Enrollment address
4 Main St
Van Buren, ME 47851009

Federally qualified health center certification: CCN 201865

Legal name
PINES HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 27, 2007
Last certification
Aug 27, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 7, 1981 in ME
Enrollment address
163 Van Buren Rd
Ste 4
Caribou, ME 47363567

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.

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
20D0887451Pines Health Services74 Access Highway, Caribou, ME 04736Provider-performed microscopyJun 17, 2027

National Provider Directory

National Provider Directory

Locations

66 Spruce St
Ste 4
Presque Isle, ME 04769
Phone 20749823592023

Ownership & related parties

All disclosed owners & managing parties 15

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 DirectorBoard Member Feb 1, 2016
Betty Hatch Individual Corporate DirectorBoard Member Oct 1, 2010
Corporate Director Oct 1, 2010
Chelsea Desrosiers Individual Corporate DirectorBoard Member Jan 1, 2019
Diane Gove Individual Corporate DirectorVice Chair Feb 23, 2022
Corporate DirectorBoard Member Feb 1, 2019
Dana Rattray Individual Corporate DirectorSecretary/Treasurer Feb 23, 2022
Corporate Director Feb 1, 2008
Tanya Sleeper Individual Corporate DirectorChair Mar 1, 2009
Corporate Director Mar 1, 2009
Lisa Caron Individual Corporate OfficerChief Operating Officer May 3, 2007
W-2 Managing EmployeeChief Operating Officer May 3, 2007
Corporate OfficerCoo May 3, 2007
W-2 Managing EmployeeCoo May 3, 2007
Jennifer Flynn Individual Corporate DirectorBoard Member Feb 1, 2016
Stev B Rogeski Individual Corporate DirectorBoard Member Jan 1, 2013
Corporate Director Jan 1, 2013
Kris Doody Individual Corporate OfficerChief Executive Officer Jan 1, 2018
W-2 Managing EmployeeChief Executive Officer Jan 1, 2018
Matthew Cummings Individual Corporate DirectorBoard Member Mar 1, 2025
Danny Gahagan Individual Corporate DirectorBoard Member Feb 1, 2024
Traci Rogers Individual Corporate OfficerCno/Coo Sep 30, 2024
W-2 Managing EmployeeCno/Coo Sep 30, 2024
Jon Holabird Individual Corporate DirectorBoard Member Jan 1, 2021
Mark Anderson Individual Corporate DirectorBoard Member Feb 1, 2023

Subparts reporting this organization as parent 7

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 100

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 100

NPI Registry JSON

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610668800000",
    "number": "1942277819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40",
            "city": "CARIBOU",
            "state": "ME",
            "postal_code": "04736",
            "telephone_number": "207-498-2350",
            "fax_number": "207-498-2352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74 ACCESS HWY",
            "city": "CARIBOU",
            "state": "ME",
            "postal_code": "04736",
            "telephone_number": "207-498-2350",
            "fax_number": "207-498-2352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINES HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-01",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A",
        "authorized_official_last_name": "CARON",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "207-498-2356"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XP3100X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Pediatric Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Caribou, ME

Sources for this page

Verify at the official NPI Registry.