Active NPI
Fore River Urology LLC
- Urology Physician
- South Portland, ME
National Provider Identifier
1003248436
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- Legal business name
- FORE RIVER UROLOGY LLC
- Practice address
- 21 Donald B Dean Dr
Suite 1
South Portland, ME 04106-3252 - Phone
- (207) 776-2411
- NPI assigned
- Aug 8, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Megan Shorey
- Title
- Office Manager
- Phone
- (207) 776-2411
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | Primary | ||
| Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician | 2088F0040X | |||
| Pediatric Urology Physician | 2088P0231X |
Addresses
Primary practice location
21 Donald B Dean Dr
Suite 1
South Portland, ME 04106-3252
Mailing address
21 Donald B Dean Dr
Suite 1
South Portland, ME 04106-3252
Phone (207) 776-2411
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service | Other | eSolutions Inc |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131127000198 | ME | Part B Supplier - Clinic/Group Practice | 5799911566 |
Receives reassigned benefits from 10 practitioners Practice locations: South Portland, ME |
| O20240216001296 | ME | DME Supplier - Physician - Urology | 5799911566 | Practice locations: South Portland, ME |
National Provider Directory
National Provider Directory- Tax ID family
- Fore River Urology LLC
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Non-Pharmacy Dispensing Site
- South Portland, ME
- NPI 1164297990
-
- Urology Physician
- South Portland, ME
- NPI 1215332606
Locations
155 Fore River Pkwy
Portland, ME 04102
Phone (207) 535-1100
21 Donald B Dean Dr
South Portland, ME 04106
Phone (207) 518-6600
Interoperability endpoints
- https://api.platform.athenahealth.com/7607/brand/1/csg/1/fhir/r4
Practitioners & affiliated clinicians
Practitioners 10
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Vascular & Interventional Radiology Physician
- Boston, MA
- NPI 1700906294
ME
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375920000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1721088000000",
"number": "1003248436",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 DONALD B DEAN DR",
"address_2": "SUITE 1",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041063252",
"telephone_number": "207-776-2411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 DONALD B DEAN DR",
"address_2": "SUITE 1",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041063252",
"telephone_number": "207-776-2411"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FORE RIVER UROLOGY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2013-08-08",
"last_updated": "2024-07-16",
"certification_date": "2024-07-16",
"status": "A",
"authorized_official_last_name": "SHOREY",
"authorized_official_first_name": "MEGAN",
"authorized_official_title_or_position": "OFFICE MANAGER",
"authorized_official_telephone_number": "207-776-2411"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Urology",
"state": null,
"license": null,
"primary": true
},
{
"code": "2088F0040X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Urology, Urogynecology and Reconstructive Pelvic Surgery",
"state": null,
"license": null,
"primary": false
},
{
"code": "2088P0231X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Urology, Pediatric Urology",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.1066.1",
"affiliationName": "eSolutions Inc",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "8215 W 108th Ter",
"city": "Overland Park",
"state": "KS",
"country_code": "US",
"postal_code": "662101661",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in South Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.