PORTLAND COMMUNITY HEALTH CENTER (NPI# 1609120856) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609120856 |
| Entity Type | Organization |
| Organization Name | PORTLAND COMMUNITY HEALTH CENTER |
| Practice Address |
180 Park Ave Portland ME 04102-2957 |
| Practice Telephone | 2078742141 |
| Mailing Telephone | 2078742141 |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2017-03-20 |
| Authorized Official Name | MS. ANN TUCKER (CFO) |
| Authorized Official Telephone | 2078742141 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679047872 | Portland Community Health Center | Clinic/Center | 52 Frederic St, Portland, ME 04102-2700 | 2019-01-22 |
| 1043783822 | Portland Community Health Center | Clinic/Center | 72 Bishop St, Portland, ME 04102-2957 | 2019-01-04 |
| 1770056558 | Portland Community Health Center | Clinic/Center | 190 Valley Street, Portland, ME 04102-2957 | 2019-01-04 |
| 1700317971 | Portland Community Health Center | Clinic/Center | 28 Portland St, Portland, ME 04101-2912 | 2017-03-21 |
| 1255872537 | Portland Community Health Center | Clinic/Center | 175 Auburn St, Portland, ME 04103-2131 | 2017-03-20 |
| 1881135192 | Portland Community Health Center | Clinic/Center | 353 Cumberland Avenue, Cliff Island, ME 04109-0008 | 2017-03-20 |
| 1053719583 | Portland Community Health Center | Clinic/Center | 211 Cumberland Ave, Portland, ME 04101-4935 | 2014-12-16 |
| 1447694344 | Portland Community Health Center | Clinic/Center | 59 Riverton Dr, Portland, ME 04103-1050 | 2013-04-22 |
| 1073144622 | Portland Community Health Center | Clinic/Center | 125 Stroudwater St, Westbrook, ME 04092-4098 | 2020-02-03 |
| 1184165466 | Portland Community Health Center | Clinic/Center | 432 Stevens Ave, Portland, ME 04103-2607 | 2017-03-20 |
| Street Address |
180 PARK AVE |
| City | PORTLAND |
| State | ME |
| Zip Code | 04102-2957 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457354540 | Carrie Frost | Pediatrics | 180 Park Ave, Portland, ME 04102-2957 | 2005-05-23 |
| 1629619002 | Daniel Kevin O'brien | Nurse Practitioner | 180 Park Ave, Portland, ME 04102-2957 | 2019-10-07 |
| 1154830073 | Heidi Sistare | Counselor | 180 Park Ave, Portland, ME 04102-2957 | 2017-09-22 |
| 1861916926 | Malual M Mabur | Physician Assistant | 180 Park Ave, Portland, ME 04102-2957 | 2017-07-31 |
| 1275900102 | Lori Nicholas | Nurse Practitioner | 180 Park Ave, Portland, ME 04102-2957 | 2015-08-26 |
| 1801278270 | Joanna Kass | Registered Nurse | 180 Park Ave, Portland, ME 04102-2957 | 2015-06-22 |
| 1215325584 | Kira Maas Sawyer | Social Worker | 180 Park Ave, Portland, ME 04102-2957 | 2015-01-08 |
| 1467859801 | Devin Shaughnessy Tetler | Nurse Practitioner | 180 Park Ave, Portland, ME 04102-2957 | 2014-12-01 |
| 1164824207 | Jennifer L. Bouldry | Social Worker | 180 Park Ave, Portland, ME 04102-2957 | 2014-09-19 |
| 1477997146 | Megan R Waterman | Family Medicine | 180 Park Ave, Portland, ME 04102-2957 | 2013-04-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720602964 | Ci Yen Joanna Man | Student in an Organized Health Care Education/Training Program | 190 Park Ave., Portland, ME 04102 | 2020-06-03 |
| 1841811338 | Abby Zarotny Sahagian | Nurse Anesthetist, Certified Registered | Mmc Anesthesia and Perioperative Medicine, 22 Bramhall St, Portland, ME 04102 | 2020-05-06 |
| 1124656863 | Zachary Bernard Tillett | Student in an Organized Health Care Education/Training Program | Maine Medical Center 22 Bramhall St., Portland, ME 04102 | 2020-03-30 |
| 1215564323 | Joshua Allen Swenson | Student in an Organized Health Care Education/Training Program | 33 Bramhall St, Portland, ME 04102 | 2020-03-26 |
| 1740776434 | Rishi Phakey | Dentist | Community Dental, 190 Park Ave, Portland, ME 04102 | 2018-07-05 |
| 1982192571 | Jessica Thomas | Doula | 619 Brighton Ave #101, Rosemont Wellness Center, Portland, ME 04102 | 2018-04-29 |
| 1699270744 | Shane D Kirkegaard | Student in an Organized Health Care Education/Training Program | Maine Medical Center 22 Bramhall Street, Portland, ME 04102 | 2018-03-29 |
| 1144752494 | Al-shawk Home Healthcare, LLC | Technician | 640 Brighton Ave Ste 8, Portland, ME 04102 | 2017-03-28 |
| 1376074674 | Samuel B Potter | Emergency Medicine | Maine Medical Center, 22 Bramhall Street, Portland, ME 04102 | 2017-03-27 |
| 1043767536 | Kevin De Ruiter | Social Worker | 129 Pine St Apt 6, Portland, ME 04102 | 2016-09-01 |
| Find all providers in zip 04102 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679047872 | Portland Community Health Center | Clinic/Center | 52 Frederic St, Portland, ME 04102-2700 | 2019-01-22 |
| 1043783822 | Portland Community Health Center | Clinic/Center | 72 Bishop St, Portland, ME 04102-2957 | 2019-01-04 |
| 1770056558 | Portland Community Health Center | Clinic/Center | 190 Valley Street, Portland, ME 04102-2957 | 2019-01-04 |
| 1427563733 | Central City Concern Inc | Clinic/Center | 1415 Se 122nd Ave, Portland, OR 97233 | 2017-12-08 |
| 1700317971 | Portland Community Health Center | Clinic/Center | 28 Portland St, Portland, ME 04101-2912 | 2017-03-21 |
| 1255872537 | Portland Community Health Center | Clinic/Center | 175 Auburn St, Portland, ME 04103-2131 | 2017-03-20 |
| 1477005619 | Outside In | Clinic/Center | 1226 Sw 12th Ave, Portland, OR 97205-2029 | 2016-11-03 |
| 1649636986 | Mainline Health Systems, Inc | Clinic/Center | 314 Highway 160 E, Portland, AR 71663-9262 | 2015-12-31 |
| 1144691098 | Central City Concern Inc | Clinic/Center | 2566 Ne Hoyt St, Portland, OR 97232-2323 | 2015-10-16 |
| 1295119386 | Central City Concern Inc | Clinic/Center | 12133 E. Burnside St, Portland, OR 97216-2344 | 2015-07-17 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.