NPIMap

Individual provider Active NPI

Truc Ta, M.D.

  • Vascular Surgery Physician
  • Portland, ME
National Provider Identifier
1114459831
Registry record updated May 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
DR.0070712 Issued in CO
Practice address
22 Bramhall St
Portland, ME 04102-3134
Phone
(207) 662-0111
NPI assigned
Mar 31, 2017
Last updated
May 18, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Vascular Surgery Physician 2086S0129X 80796 AZ
Vascular Surgery Physician 2086S0129X DR.0070712 CO Primary

Addresses

Primary practice location

22 Bramhall St
Portland, ME 04102-3134

Mailing address

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 662-0111

Other practice location 1

2270 S Ridgeview Dr Ste 201
Yuma, AZ 85364-8880
Phone (928) 344-5055

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, AZ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230807002844 CO Practitioner - Vascular Surgery 4688947484 Reassigns benefits to 2 organizations
I20260608001341 AZ Practitioner - Vascular Surgery 4688947484 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Albany Medical College of Union University, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

360 W Park Dr
Intermountain Health Heart and Vascular Wes
Grand Junction, CO 81505-1448
Phone (970) 298-3050

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal14
Leg revascularization (restoring blood flow)12
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
80796AZMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Group Denver, LLC CurrentSince Jan 4, 2026 Accepting new patients
Intermountain Medical Group Denver, LLC CurrentSince Jan 4, 2026 Accepting new patients
Intermountain Medical Group Grand Junction, LLC CurrentSince Aug 1, 2023 Accepting new patients
Intermountain Medical Group Grand Junction, LLC Current Accepting new patients
Intermountain Medical Group Grand Junction, LLC CurrentSince Aug 1, 2023 Accepting new patients
Intermountain Medical Group Denver, LLC PastSince Feb 26, 2023 Accepting new patients
Yuma Regional Medical Center PastSince Jun 24, 2026 Accepting new patients
St Mary's Hospital and Medical Center, Inc Past Accepting new patients
St. Mary's Hospital and Medical Center, Inc. Past Accepting new patients

Locations

1050 Wellington Ave
Grand Junction, CO 81501
Phone (970) 245-4810

1050 Wellington Ave
Slp Ctr
Grand Junction, CO 81501
Phone (970) 298-5864

2643 Patterson Rd
Ste 605
Grand Junction, CO 81506
Phone (970) 244-2482

360 W Park Dr
Grand Junction, CO 81505
Phone (970) 244-2482

340 Exempla Cir
Ste 300
Lafayette, CO 80026
Phone (303) 673-1390

Organizations & group practices 10

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 5

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": "1490918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779062400000",
    "number": "1114459831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 BRAMHALL ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023134",
            "telephone_number": "207-662-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 BRAMHALL ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023134",
            "telephone_number": "207-662-0111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2270 S Ridgeview Dr Ste 201",
            "address_purpose": "LOCATION",
            "city": "Yuma",
            "state": "AZ",
            "postal_code": "853648880",
            "country_code": "US",
            "telephone_number": "928-344-5055",
            "fax_number": "928-336-6290",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TA",
        "first_name": "TRUC",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-31",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "AZ",
            "license": "80796",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CO",
            "license": "DR.0070712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.