NPIMap

Organization Active NPI

Convenientmd LLC

  • Family Medicine Physician
  • Portsmouth, NH
National Provider Identifier
1114689007
Registry record updated Nov 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CONVENIENTMD LLC
Practice address
1600 Woodbury Ave
Portsmouth, NH 03801-3250
Phone
(603) 602-9070
NPI assigned
Oct 8, 2021
Last updated
Nov 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2023

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

Authorized official

Name
Jarod Boissonneault
Title
Director of Revenue Cycle MGT
Phone
(603) 319-6223

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1600 Woodbury Ave
Portsmouth, NH 03801-3250

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 NH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130410000222 NH Part B Supplier - Clinic/Group Practice 2062667033 Receives reassigned benefits from 10 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Windham, NH; Stratham, NH; Portsmouth, NH; Dover, NH; Plaistow, NH; Nashua, NH; Merrimack, NH; Manchester, NH…

Other NPIs on the same Medicare enrollment 18

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 18

National Provider Directory

National Provider Directory
Tax ID family
Convenientmd LLC29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

Organizations that report the same tax identification number in the National Provider Directory.

View all 28

Locations

211 Marginal Way
Portland, ME 04101
Phone (207) 517-3838

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1633651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701302400000",
    "number": "1114689007",
    "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": "1600 WOODBURY AVE",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038013250",
            "telephone_number": "603-602-9070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONVENIENTMD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-08",
        "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 REVENUE CYCLE MGT",
        "authorized_official_telephone_number": "603-319-6223"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portsmouth, NH

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.

Verify at the official NPI Registry.