Active NPI
Kelly Doris Whitaker, RDN
- Registered Dietitian
- South Portland, ME
National Provider Identifier
1043848039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- DI149
- Practice address
- 41 Donald B Dean Dr
South Portland, ME 04106-3252 - Phone
- (207) 661-6064
- NPI assigned
- Mar 27, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DI149 | ME | Primary |
Addresses
Primary practice location
41 Donald B Dean Dr
South Portland, ME 04106-3252
Mailing address
41 Donald B Dean Dr
South Portland, ME 04106-3252
Phone (072) 661-6064
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Registered Dietitian Or Nutrition Professional
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
22 Bramhall St
Portland, ME 04102-3134
Phone (207) 885-9905
41 Donald B Dean Dr
South Portland, ME 04106-3252
Hospital & facility affiliations
- Mainehealth Maine Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DI149 | ME | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mainehealth | Current | Accepting new patients | |
| Mainehealth | Current | Accepting new patients | |
| Mainehealth | Current | Accepting new patients |
Locations
35 Miles St
Damariscotta, ME 04543
Phone (207) 563-1234
22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179
Organizations & group practices 3
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.
-
- Psychiatric Hospital
- Westbrook, ME
- NPI 1790265502
-
- Community/Retail Pharmacy
- Portland, ME
- NPI 1013868181
-
- General Acute Care Hospital
- Portland, ME
- NPI 1760436216
Hospital & facility affiliations 36
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Scarborough, ME
- NPI 1053647024
-
- General Acute Care Hospital
- Portland, ME
- NPI 1346267879
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725494400000",
"number": "1043848039",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41 DONALD B DEAN DR",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041063252",
"telephone_number": "072-661-6064"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41 DONALD B DEAN DR",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041063252",
"telephone_number": "207-661-6064"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITAKER",
"first_name": "KELLY",
"middle_name": "DORIS",
"credential": "RDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-27",
"last_updated": "2024-09-05",
"certification_date": "2024-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "ME",
"license": "DI149",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"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 Sep 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.