Active NPI
Convenientmd LLC
- Urgent Care Clinic/Center
- Sanford, ME
National Provider Identifier
1093460479
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urgent Care Clinic/Center
- Legal business name
- CONVENIENTMD LLC
- Practice address
- 1420 Main St
Sanford, ME 04073 - Phone
- (207) 850-5744
- NPI assigned
- Feb 15, 2022
- Last updated
- Nov 30, 2023
- 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
- Jarod Boissonneault
- Title
- Director of Rev Cycle MGT
- Phone
- (603) 319-6223
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urgent Care Clinic/Center | 261QU0200X | Primary |
Addresses
Primary practice location
1420 Main St
Sanford, ME 04073
Mailing address
360 US Highway 1 Byp Unit 102
Portsmouth, NH 03801-7105
Phone (603) 410-6700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180220000535 | ME | Part B Supplier - Clinic/Group Practice | 2062667033 |
Receives reassigned benefits from 9 practitioners 12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Ellsworth, ME; Saco, ME; Sanford, ME; Westbrook, ME; Portland, ME; Bangor, ME; Augusta, ME; Auburn, ME… |
Other NPIs on the same Medicare enrollment 12
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1644883200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1701302400000",
"number": "1093460479",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "360 US HIGHWAY 1 BYP UNIT 102",
"city": "PORTSMOUTH",
"state": "NH",
"postal_code": "038017105",
"telephone_number": "603-410-6700",
"fax_number": "603-319-8308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1420 MAIN ST",
"city": "SANFORD",
"state": "ME",
"postal_code": "04073",
"telephone_number": "207-850-5744"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CONVENIENTMD LLC",
"organizational_subpart": "NO",
"enumeration_date": "2022-02-15",
"last_updated": "2023-11-30",
"certification_date": "2023-11-30",
"status": "A",
"authorized_official_last_name": "BOISSONNEAULT",
"authorized_official_first_name": "JAROD",
"authorized_official_title_or_position": "DIRECTOR OF REV CYCLE MGT",
"authorized_official_telephone_number": "603-319-6223"
},
"taxonomies": [
{
"code": "261QU0200X",
"taxonomy_group": "",
"desc": "Clinic/Center, Urgent Care",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sanford, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2023; 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.