NPIMap

Organization Active NPI

Memorial Hospital

Doing business as MaineHealth Memorial Hospital

  • Family Medicine Physician
  • North Conway, NH
National Provider Identifier
1992000103
Registry record updated Aug 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MEMORIAL HOSPITAL
Doing business as
MaineHealth Memorial Hospital
Physicians at Memorial Hospital
Practice address
3073 White Mountain Hwy
North Conway, NH 03860-7101
Phone
(603) 356-5461
Fax
(603) 356-5877
NPI assigned
Jan 19, 2011
Last updated
Aug 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2024

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

Authorized official

Name
Diana J McLaughlin
Title
Chief Financial Officer
Phone
(603) 356-0613

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X
Hematology & Oncology Physician 207RH0003X
Obstetrics & Gynecology Physician 207V00000X
Orthopaedic Surgery Physician 207X00000X
Surgery Physician 208600000X
Urology Physician 208800000X
Hospitalist Physician 208M00000X

Addresses

Primary practice location

3073 White Mountain Hwy
North Conway, NH 03860-7101

Mailing address

PO Box 360558
Pittsburgh, PA 15251-6558
Phone (603) 356-5461

Other practice location 1

3107 White Mountain Hwy
North Conway, NH 03860
Phone (603) 356-7061

Other names 2

  • MaineHealth Memorial Hospital Doing business as
  • Physicians at Memorial Hospital Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040907000095 NH Part B Supplier - Clinic/Group Practice 2365418993 Receives reassigned benefits from 176 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: North Conway, NH
O20061104000389 NH Part A Provider - Critical Access Hospital 2365418993 Receives reassigned benefits from 175 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: North Conway, NH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992000103. Details of each certification follow.

Hospital certification: CCN 301307

Legal name
MEMORIAL HOSPITAL
Doing business as
MAINEHEALTH MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Oct 18, 2004
Last certification
Sep 29, 2022
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Aug 30, 1910 in NH
Enrollment address
3073 White Mountain Hwy
North Conway, NH 38607101
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Memorial Hospital, theCCN 301307 · All quality measures
Overall star rating
4 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

119 Northport Ave
Ste 2
Belfast, ME 04915

9 Healthcare Dr
Ste 112
Biddeford, ME 04005

159 Main St
#2
Norway, ME 04268

22 Bramhall St
#D
Portland, ME 04102

3 Glen Cove Dr
#1
Rockport, ME 04856
Phone (207) 301-8900

4 Glen Cove Dr
Rockport, ME 04856
Phone (207) 301-5500

4 Glen Cove Dr
Ste 103
Rockport, ME 04856
Phone (207) 301-5737

25 June St
Ste 12
Sanford, ME 04073

100 Brickhill Ave
Ste 203
South Portland, ME 04106
Phone (207) 522-7482

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
Dawn M Tutt Individual W-2 Managing EmployeeManager RCM Systems Support Jun 23, 2021
Corinne Ray Individual Corporate OfficerSecretary Dec 1, 2021
Corporate Director Jan 1, 2018
Andrew T Mueller Individual Corporate Director Apr 19, 2021
Diana J McLaughlin Individual Corporate OfficerChief Financial Officer Mar 1, 2020
W-2 Managing EmployeeChief Financial Officer Jul 1, 2016
Tricia Costigan Individual Corporate Officer Feb 17, 2025
W-2 Managing EmployeePresident Feb 17, 2025
Christopher C Perley Individual Corporate OfficerVice Chair Dec 1, 2021
Corporate Director Dec 1, 2020
Rachael R Brown Individual Corporate Director May 1, 2024
Christine Thompson Individual Corporate Director May 1, 2024
Mainehealth Services Organization, Portland, ME Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2014 100%
Linda M. Terry Individual Corporate OfficerTreasurer Dec 1, 2021
Corporate Director Aug 1, 2019
Donna Jauregui Individual W-2 Managing EmployeeDirector Provider Enrollment Cvo Aug 2, 2025
Theresa Struble Individual W-2 Managing EmployeeExecutive Assistant Jan 6, 2025
Timothy G. Scott Individual Corporate Director Dec 1, 2019
Stephen J Boyle Individual Corporate Director Dec 1, 2021
Mary a Vigeant Individual Corporate DirectorBoard Member Jul 1, 2017

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 98

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 98

Affiliated clinicians 389

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

View all 389

NPI Registry JSON

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

{
    "created_epoch": "1295395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723075200000",
    "number": "1992000103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 360558",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152516558",
            "telephone_number": "603-356-5461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3073 WHITE MOUNTAIN HWY",
            "city": "NORTH CONWAY",
            "state": "NH",
            "postal_code": "038607101",
            "telephone_number": "603-356-5461",
            "fax_number": "603-356-5877"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3107 White Mountain Hwy",
            "address_purpose": "LOCATION",
            "city": "North Conway",
            "state": "NH",
            "postal_code": "03860",
            "country_code": "US",
            "telephone_number": "603-356-7061",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-19",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A",
        "authorized_official_last_name": "MCLAUGHLIN",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "603-356-0613"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "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
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "MaineHealth Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Physicians at Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Conway, NH

Sources for this page

Verify at the official NPI Registry.