Individual provider Active NPI

Eileen Poulin, MD

  • Pediatrics Physician
  • Portland, ME
National Provider Identifier
1124146923
Registry record updated Nov 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD12470 Issued in ME
Practice address
22 Bramhall St
Portland, ME 04102-3134
Phone
(207) 662-2911
NPI assigned
Mar 27, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD12470 ME Primary

Addresses

Primary practice location

22 Bramhall St
Portland, ME 04102-3134

Mailing address

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 662-2911

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050818000840 ME Practitioner - Pediatric Medicine 7214967264 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD12470MEMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Jan 1, 2014 Accepting new patients
Maine Medical Partners CurrentSince Dec 29, 2019 Accepting new patients
Maine Medical Partners CurrentSince Dec 29, 2019 Accepting new patients
Mainehealth CurrentSince Jul 31, 2018 Accepting new patients
Maine Medical Partners Pediatrics CurrentSince Apr 1, 2020 Accepting new patients
Mainehealth Current Accepting new patients
Mainehealth CurrentSince Jan 1, 2014 Accepting new patients

Locations

1577 Congress St
Ste 1
Portland, ME 04102
Phone (207) 662-1442

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

272 Congress St
Portland, ME 04101
Phone (207) 874-2466

1 Harnois Ave
Ste 1A
Westbrook, ME 04092
Phone (207) 662-1360

1 Harnois Ave
Ste 2
Westbrook, ME 04092
Phone (207) 661-3400

Interoperability endpoints

  • Direct secure messaging: epoulin1074@direct.mmc.mainehealth.org

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385078400000",
    "number": "1124146923",
    "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": "207-662-2911"
        },
        {
            "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": "207-662-2911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULIN",
        "first_name": "EILEEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-27",
        "last_updated": "2013-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ME",
            "license": "MD12470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.