NPIMap

Individual provider Active NPI

Jon Patrick Donnelly, M.D

  • Pediatric Cardiology Physician
  • Scarborough, ME
National Provider Identifier
1023102456
Registry record updated Jan 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
MD14324 Issued in ME
Practice address
71 US Route 1
Suite C
Scarborough, ME 04074-7173
Phone
(207) 883-5532
NPI assigned
Oct 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X MD14324 ME Primary

Addresses

Primary practice location

71 US Route 1
Suite C
Scarborough, ME 04074-7173

Mailing address

5 Pearl Street
Cape Elizabeth, ME 04107
Phone (207) 799-6096

Other practice location 1

93 Campus Ave
Lewiston, ME 04240-6030
Phone (207) 755-3240

Other identifiers 1

IdentifierTypeStateIssuer
315420099MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050524000880 ME Practitioner - Pediatric MedicinePractitioner - Cardiovascular Disease (Cardiology)Practitioner - Other (Physician) 7911949516 Reassigns benefits to 4 organizations
Practice locations: Portland, ME

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
University of North Carolina at Chapel Hill School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 885-9905

71 US Route 1
Suite C
Scarborough, ME 04074-7174
Phone (207) 883-5532

Hospital & facility affiliations

  • Mainehealth Maine Medical Center Hospital, Portland, ME, CCN 200009

Merit-based Incentive Payment System (MIPS)

Final score
97.93 of 100Reported as apm
Quality
83.31
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth Current Accepting new patients
Mainehealth CurrentSince Nov 1, 2018 Accepting new patients
St. Mary'S Regional Medical Center CurrentSince Dec 9, 2019 Accepting new patients
St. Mary'S Regional Medical Center Current Accepting new patients
Mainehealth CurrentSince Sep 1, 2013 Accepting new patients
Maine Medical Partners CurrentSince Feb 24, 2019 Accepting new patients
Mainehealth CurrentSince Nov 1, 2018 Accepting new patients
St. Mary'S Regional Medical Center CurrentSince Dec 9, 2019 Accepting new patients
Maine Medical Partners CurrentSince Feb 24, 2019 Accepting new patients
Mainehealth Past Accepting new patients
Mainehealth Past Accepting new patients

Locations

791 Turner St
#2
Auburn, ME 04210
Phone (207) 330-3900

111 Franklin Health Cmns
Farmington, ME 04938
Phone (207) 778-3326

93 Campus Ave
Lewiston, ME 04240
Phone (207) 755-3715

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

887 Congress St
Ste 310
Portland, ME 04102
Phone (207) 773-2723

887 Congress St
Ste 200
Portland, ME 04102
Phone (207) 771-5549

71 US Route 1
Ste C
Scarborough, ME 04074
Phone (207) 883-5532

Interoperability endpoints

  • Direct secure messaging: jdonnelly718@direct.mmc.mainehealth.org

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 36

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578009600000",
    "number": "1023102456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 PEARL STREET",
            "city": "CAPE ELIZABETH",
            "state": "ME",
            "postal_code": "04107",
            "telephone_number": "207-799-6096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 US ROUTE 1",
            "address_2": "SUITE C",
            "city": "SCARBOROUGH",
            "state": "ME",
            "postal_code": "040747173",
            "telephone_number": "207-883-5532"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "93 Campus Ave",
            "address_purpose": "LOCATION",
            "city": "Lewiston",
            "state": "ME",
            "postal_code": "042406030",
            "country_code": "US",
            "telephone_number": "207-755-3240",
            "fax_number": "207-755-3246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DONNELLY",
        "first_name": "JON",
        "middle_name": "PATRICK",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2020-01-03",
        "certification_date": "2020-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "ME",
            "license": "MD14324",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "315420099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Scarborough, ME

Sources for this page

Verify at the official NPI Registry.