NPIMap

Individual provider Active NPI

Lars M Ellison, MD

  • Urology Physician
  • Rockport, ME
National Provider Identifier
1114902749
Registry record updated May 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
MD17463 Issued in ME
Practice address
3 Glen Cove Dr Ste 3
Rockport, ME 04856-4232
Phone
(207) 301-5400
Fax
(207) 301-5301
NPI assigned
Dec 6, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X MD17463 ME Primary
Urology Physician 208800000X A83598 CA

Addresses

Primary practice location

3 Glen Cove Dr Ste 3
Rockport, ME 04856-4232

Mailing address

3 Glen Cove Dr Ste 3
Rockport, ME 04856-4232
Phone (207) 301-5400

Other practice location 1

125 Northport Ave Ste 106
Belfast, ME 04915-6002
Phone (207) 505-4080

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
I20070706000014 ME Practitioner - Urology 1951401827 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Boston University School of Medicine, 1995
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)

116 Northport Ave
216 WCMP Nephrology
Belfast, ME 04915-6002
Phone (207) 505-4080

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

3 Glen Cove Dr
Rockport, ME 04856-4232

6 Glen Cove Dr
Rockport, ME 04856-4272
Phone (207) 921-8969

Hospital & facility affiliations

  • Mainehealth Pen Bay Hospital Hospital, Rockport, ME, CCN 200063
  • Mainehealth Waldo Hospital Hospital, Belfast, ME, CCN 201312
  • Lincolnhealth Hospital, Damariscotta, ME, CCN 201302
  • Mainehealth Maine Medical Center Hospital, Portland, ME, CCN 200009

Merit-based Incentive Payment System (MIPS)

Final score
97.93 of 100Reported as apm
Quality
83.31
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection12

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth Current Accepting new patients
Mainehealth CurrentSince Oct 1, 2018 Accepting new patients
Mainehealth CurrentSince Oct 1, 2018 Accepting new patients
Mainegeneral Medical Center CurrentSince Dec 11, 2025 Accepting new patients
Mainegeneral Medical Center CurrentSince Dec 11, 2025 Accepting new patients
Penobscot Bay Physicians & Associates CurrentSince Jul 1, 2007 Accepting new patients
Mainehealth CurrentSince Jul 1, 2012 Accepting new patients
Mainehealth Past Accepting new patients

Locations

442 Civic Center Dr
Augusta, ME 04330
Phone (207) 622-6319

118 Northport Ave
Belfast, ME 04915
Phone (207) 338-9345

125 Northport Ave
#106
Belfast, ME 04915
Phone (207) 301-3090

116 Northport Ave
Ste 220
Belfast, ME 04915
Phone (207) 505-4015

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

3 Glen Cove Dr
#3
Rockport, ME 04856
Phone (207) 301-5400

149 North St
Waterville, ME 04901
Phone (207) 622-1959

Interoperability endpoints

  • Direct secure messaging: lellison10502@direct.mmc.mainehealth.org

Organizations & group practices 8

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 39

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

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747699200000",
    "number": "1114902749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 GLEN COVE DR STE 3",
            "city": "ROCKPORT",
            "state": "ME",
            "postal_code": "048564232",
            "telephone_number": "207-301-5400",
            "fax_number": "207-301-5301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 GLEN COVE DR STE 3",
            "city": "ROCKPORT",
            "state": "ME",
            "postal_code": "048564232",
            "telephone_number": "207-301-5400",
            "fax_number": "207-301-5301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "125 Northport Ave Ste 106",
            "address_purpose": "LOCATION",
            "city": "Belfast",
            "state": "ME",
            "postal_code": "049156002",
            "country_code": "US",
            "telephone_number": "207-505-4080",
            "fax_number": "207-800-4338",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "LARS",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-06",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "ME",
            "license": "MD17463",
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CA",
            "license": "A83598",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockport, ME

Sources for this page

Verify at the official NPI Registry.