NPIMap

Organization Active NPI

City of Portland

Doing business as City of Portland Medcu

  • Land Ambulance
  • Portland, ME
National Provider Identifier
1134185648
Registry record updated Apr 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
0546 Issued in ME
Legal business name
CITY OF PORTLAND
Doing business as
City of Portland Medcu
Practice address
380 Congress St
Portland, ME 04101-3513
Phone
(207) 874-8400
Fax
(207) 874-8410
NPI assigned
Apr 24, 2006
Last updated
Apr 27, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2019

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

Authorized official

Name
Christopher H Goodall
Title
Assistant Fire Chief
Phone
(207) 874-8409

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 546 ME
Land Ambulance 3416L0300X 0546 ME Primary

Addresses

Primary practice location

380 Congress St
Portland, ME 04101-3513

Mailing address

PO Box 16020
Lewiston, ME 04243-9597
Phone (207) 874-8400

Other identifiers 3

IdentifierTypeStateIssuer
136040100MedicaidME
1001171OtherMEBLUE CROSS
441590199OtherMERAILROAD MEDICARE

Other names 1

  • City of Portland Medcu Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070913000380 ME Part B Supplier - Ambulance Service Supplier 4082708615 Practice locations: Portland, ME

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
20D0710252City of Portland Maine - Fire Department380 Congress Street, Portland, ME 04101Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Portland City Hospital10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Barron CenterPortland, ME, CCN 205011 Skilled nursing facility Operational/Managerial Control Nov 2, 2021

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1145836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556323200000",
    "number": "1134185648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16020",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042439597",
            "telephone_number": "207-874-8400",
            "fax_number": "207-874-8410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 CONGRESS ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041013513",
            "telephone_number": "207-874-8400",
            "fax_number": "207-874-8410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF PORTLAND",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-24",
        "last_updated": "2019-04-27",
        "status": "A",
        "authorized_official_last_name": "GOODALL",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "ASSISTANT FIRE CHIEF",
        "authorized_official_telephone_number": "207-874-8409"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "ME",
            "license": "546",
            "primary": false
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "ME",
            "license": "0546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136040100",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "1001171",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "441590199",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "City of Portland Medcu",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.