NPIMap

Individual provider Active NPI

Peter Beaulieu, D.O.

  • Vascular Surgery Physician
  • Bangor, ME
National Provider Identifier
1053750349
Registry record updated Feb 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
DO2999 Issued in ME
Practice address
489 State St
Bangor, ME 04401-6616
Phone
(207) 973-7000
NPI assigned
Jun 19, 2013
Last updated
Feb 4, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X DO2999 ME Primary

Addresses

Primary practice location

489 State St
Bangor, ME 04401-6616

Mailing address

43 Whiting Hill Rd Ste 300
Brewer, ME 04412-1006

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
I20200201000122 ME Practitioner - Vascular Surgery 4486882768 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
University of New England, College of Osteo Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Aroostook Medical CenterGroup PAC ID 1153233663, 117 clinicians
Eastern Maine Medical CenterGroup PAC ID 2062315161, 659 clinicians

Practice addresses (Care Compare)

140 Academy St
Presque Isle, ME 04769-3102

146 Academy St
Presque Isle, ME 04769-3102

234 State St
Brewer, ME 04412-1519
Phone (207) 989-0550

33 Whiting Hill Rd
Brewer, ME 04412-1021
Phone (207) 973-7478

489 State St
Bangor, ME 04401-6616
Phone (207) 973-7000

55 Broadway
Suite 2
Bangor, ME 04401-5201
Phone (207) 947-0469

7 Main Rd N
Northern Light Primary
Hampden, ME 04444-1334
Phone (207) 862-9400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal1-10
Leg revascularization (restoring blood flow)15

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO2999MEMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Aroostook Medical Center CurrentSince Mar 15, 2020 Accepting new patients
Eastern Maine Medical Center CurrentSince Feb 2, 2020 Accepting new patients
Eastern Maine Medical Center CurrentSince Feb 2, 2020 Accepting new patients
The Aroostook Medical Center CurrentSince Mar 15, 2020 Accepting new patients

Locations

489 State St
Bangor, ME 04401
Phone (207) 973-8837

489 State St
Ste A
Bangor, ME 04401

43 Whiting Hill Rd
Ste 300
Brewer, ME 04412
Phone (207) 973-5000

140 Academy St
#10
Presque Isle, ME 04769
Phone (207) 764-3734

140 Academy St
Ste 10
Presque Isle, ME 04769
Phone (207) 764-3734

Interoperability endpoints

  • Direct secure messaging: pbeaulieu83699@epic00.shdirect.org

Organizations & group practices 4

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

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1371600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580774400000",
    "number": "1053750349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 WHITING HILL RD STE 300",
            "city": "BREWER",
            "state": "ME",
            "postal_code": "044121006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "489 STATE ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016616",
            "telephone_number": "207-973-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAULIEU",
        "first_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-19",
        "last_updated": "2020-02-04",
        "certification_date": "2020-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "ME",
            "license": "DO2999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.