NPIMap

Organization Active NPI

Portland Community Health Center

Doing business as Greater Portland Health

  • Federally Qualified Health Center (FQHC)
  • Portland, ME
National Provider Identifier
1982338240
Registry record updated Jul 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PORTLAND COMMUNITY HEALTH CENTER
Doing business as
Greater Portland Health
Practice address
295 Park Ave
Portland, ME 04102-2911
Phone
(207) 874-2141
Fax
(207) 761-3738
NPI assigned
Jul 13, 2022
Last updated
Jul 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2024

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

Authorized official

Name
Ann F Tucker
Title
Ceo
Phone
(207) 874-2141

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Non-emergency Medical Transport (VAN) 343900000X

Addresses

Primary practice location

295 Park Ave
Portland, ME 04102-2911

Mailing address

180 Park Ave
Portland, ME 04102-2957
Phone (207) 874-2141

Other names 1

  • Greater Portland Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20130206000120 ME Part B Supplier - Clinic/Group Practice 5395998017 Receives reassigned benefits from 73 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Westbrook, ME; South Portland, ME; Portland, ME
O20220930001197 ME Part A Provider - Federally Qualified Health Center (FQHC) 5395998017 Practice locations: Portland, ME
O20250328000940 ME DME Supplier - Physician - Optometrist 5395998017 Practice locations: Portland, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982338240. Details of each certification follow.

Federally qualified health center certification: CCN 201965

Legal name
PORTLAND COMMUNITY HEALTH CENTER
Doing business as
GREATER PORTLAND HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 29, 2022
Last certification
Sep 29, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 30, 2013 in ME
Enrollment address
295 Park Ave
Portland, ME 41022911

Other NPIs with the same Medicare PAC ID 17

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

View all 17

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory
Tax ID family
Portland Community Health Center43 organizations share this tax ID, including this one

Other organizations with this tax ID 42

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

View all 42

Locations

234 Oxford St
Portland, ME 04101

370 Stevens Ave
Portland, ME 04103
Phone (207) 450-9981

654 Riverside St
Portland, ME 04103

120 Wescott Rd
South Portland, ME 04106

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Axel Nimbona Individual Corporate DirectorBoard Member Apr 16, 2024
Ann Tucker Individual Corporate OfficerCeo May 20, 2017
W-2 Managing EmployeeCeo May 20, 2017
Paul Santomenna Individual Corporate DirectorPresident Dec 26, 2017
Belviga Mpolo Individual Corporate DirectorBoard Member Jan 27, 2026
Christine Caulfield Individual Corporate DirectorVice President Jan 24, 2023
Connor O'Neill Individual Corporate DirectorBoard Member Apr 16, 2024
Christopher Dana Individual Corporate DirectorSecretary Jul 27, 2021
Isaac Macdougal Individual Corporate DirectorBoard Member Apr 16, 2024
Marie a Guay Individual Corporate DirectorBoard Member Apr 16, 2024
Richard M White Individual Corporate DirectorTreasurer Jan 24, 2017
Doreen Karigirwa Individual Corporate DirectorBoard Member Jan 27, 2026
John Dearmond Individual Corporate DirectorBoard Member Jan 27, 2026

Practitioners & affiliated clinicians

Practitioners 70

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 70

NPI Registry JSON

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

{
    "created_epoch": "1657670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721952000000",
    "number": "1982338240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 PARK AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022957",
            "telephone_number": "207-874-2141",
            "fax_number": "207-761-3738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 PARK AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022911",
            "telephone_number": "207-874-2141",
            "fax_number": "207-761-3738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-13",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "ANN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-874-2141"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greater Portland Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Greater Portland Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.