NPIMap

Individual provider Active NPI

Christina Marie Mimikos, D.O.

  • Otolaryngology/Facial Plastic Surgery Physician
  • Portland, ME
National Provider Identifier
1093944258
Registry record updated Oct 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
License
2016017553 Issued in MO
Practice address
1250 Forest Ave Ste 301
Portland, ME 04103
Phone
(207) 797-5753
NPI assigned
Jul 9, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X 2016017553 MO Primary
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X 5101018354 MI

Addresses

Primary practice location

1250 Forest Ave Ste 301
Portland, ME 04103

Mailing address

1250 Forest Ave Ste 301
Portland, ME 04103-1884
Phone (207) 797-5753

Other practice location 1

1229 E Seminole St
Suite 520
Springfield, MO 65804-2227
Phone (417) 820-5750

Other identifiers 2

IdentifierTypeStateIssuer
PENDINGMedicaidAR
PENDINGMedicaidMO

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
I20181024000187 ME Practitioner - Otolaryngology 8820231905 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MainehealthGroup PAC ID 7517860588, shared by 31 NPIs, 2,616 clinicians

Practice addresses (Care Compare)

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

92 Campus Dr
Scarborough, ME 04074-7229

Hospital & facility affiliations

  • Mainehealth Maine Medical Center Hospital, Portland, ME, CCN 200009
  • Maine General Medical Center Hospital, Augusta, ME, CCN 200039

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101018354MIMDOtolaryngology/Facial Plastic Surgery Physician
2016017553MOMDOtolaryngology/Facial Plastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth Current Accepting new patients
Maine Medical Partners Current Accepting new patients
Mainehealth CurrentSince Oct 1, 2018 Accepting new patients
Mainehealth CurrentSince Oct 1, 2018 Accepting new patients
Mainehealth Current Accepting new patients
Maine Medical Partners CurrentSince Oct 1, 2018 Accepting new patients
Maine Medical Partners CurrentSince Oct 1, 2018 Accepting new patients
Ozarks Medical Center Past Accepting new patients
Mainehealth Past Accepting new patients

Locations

1250 Forest Ave
Ste 301
Portland, ME 04103
Phone (207) 797-5753

1250 Forest Ave
Portland, ME 04103
Phone (207) 797-5753

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

92 Campus Dr
Ste C
Scarborough, ME 04074
Phone (207) 797-5753

175 US Route 1
Scarborough, ME 04074
Phone (207) 396-7700

584 Roosevelt Trl
Windham, ME 04062
Phone (207) 892-3216

Interoperability endpoints

  • Direct secure messaging: cmimikos231558@direct.mmc.mainehealth.org

Organizations & group practices 9

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": "1247097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539907200000",
    "number": "1093944258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 FOREST AVE STE 301",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041031884",
            "telephone_number": "207-797-5753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 FOREST AVE STE 301",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04103",
            "telephone_number": "207-797-5753"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1229 E Seminole St",
            "address_2": "Suite 520",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658042227",
            "country_code": "US",
            "telephone_number": "417-820-5750",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIMIKOS",
        "first_name": "CHRISTINA",
        "middle_name": "MARIE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-09",
        "last_updated": "2018-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "MO",
            "license": "2016017553",
            "primary": true
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "MI",
            "license": "5101018354",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.