NPIMap

Organization Active NPI

DFD Russell Medical Center Inc

  • Federally Qualified Health Center (FQHC)
  • Leeds, ME
National Provider Identifier
1952482804
Registry record updated Feb 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
DFD RUSSELL MEDICAL CENTER INC
Practice address
180 Church Hill Rd
Suite 1
Leeds, ME 04263-3418
Phone
(207) 524-3501
Fax
(207) 524-2459
NPI assigned
Oct 18, 2006
Last updated
Feb 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2024

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

Authorized official

Name
Laurie A Kane-Lewis
Title
Ceo
Phone
(207) 524-3501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X ME Primary

Addresses

Primary practice location

180 Church Hill Rd
Suite 1
Leeds, ME 04263-3418

Mailing address

180 Church Hill Rd
Suite 1
Leeds, ME 04263-3418
Phone (207) 524-3501

Other identifiers 1

IdentifierTypeStateIssuer
168270000MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040929000224 ME Part B Supplier - Clinic/Group Practice 3274502000 Receives reassigned benefits from 15 practitioners
1 other NPI on this enrollment
Practice locations: Leeds, ME; Monmouth, ME; Turner, ME
O20100927001143 ME Part A Provider - Federally Qualified Health Center (FQHC) 3274502000 Practice locations: Leeds, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952482804. Details of each certification follow.

Federally qualified health center certification: CCN 201827

Legal name
DFD RUSSELL MEDICAL CENTER INC
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
Oct 16, 1979 in ME
Enrollment address
180 Church Hill Rd
Ste 1
Leeds, ME 42633418

Other NPIs with the same Medicare PAC ID 2

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

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
20D0671429DFD Russell Medical Center180 Church Hill Rd Suite 1, Leeds, ME 04263Provider-performed microscopyJun 30, 2027

National Provider Directory

National Provider Directory

Locations

180 Church Hill Rd
#1
Leeds, ME 04263
Phone (207) 524-3501

180 Church Hill Rd
Ste 1A
Leeds, ME 04263

7 Main St
Turner, ME 04282
Phone (207) 225-2676

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
Crystal Barus Individual Corporate Director Mar 21, 2018
Dale Hinds Individual Corporate DirectorBoard of Directors Member Jul 24, 2013
Gary Dougherty Individual Corporate DirectorBoard Member Mar 21, 2018 100%
Gary S Rivard Individual Corporate DirectorMedical Director May 1, 2017 100%
Veronica Wiegman Individual Corporate DirectorBoard of Directors Member Oct 1, 2008
Laurie a Kane Individual Corporate OfficerCeo Feb 22, 2007 100%
W-2 Managing Employee Jan 12, 2004
Lindsey Sawyer-Brown Individual Corporate DirectorDirector Oct 24, 2018
Michael P Payne Individual Corporate OfficerChief Financial Officer Jun 6, 2013
Theresa Gillis Individual Corporate DirectorBoard Member Dec 1, 2008
Michael Eaton Individual Corporate DirectorBoard of Directors Member May 28, 2014
Martha Geores Individual Corporate DirectorDirector Feb 26, 2020

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
DFD Russell Medical Center IncMonmouth, ME, CCN 201888 Federally qualified health center Operational/Managerial Control Sep 27, 2010

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Subparts reporting this organization as parent 1

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

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707436800000",
    "number": "1952482804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 CHURCH HILL RD",
            "address_2": "SUITE 1",
            "city": "LEEDS",
            "state": "ME",
            "postal_code": "042633418",
            "telephone_number": "207-524-3501",
            "fax_number": "207-524-2459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 CHURCH HILL RD",
            "address_2": "SUITE 1",
            "city": "LEEDS",
            "state": "ME",
            "postal_code": "042633418",
            "telephone_number": "207-524-3501",
            "fax_number": "207-524-2459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DFD RUSSELL MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A",
        "authorized_official_last_name": "KANE-LEWIS",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-524-3501"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "ME",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168270000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Leeds, ME

Sources for this page

Verify at the official NPI Registry.