Individual provider Active NPI

Mark Erin Sutherland, DO

  • Neuromusculoskeletal Medicine & OMM Physician
  • Waterville, ME
National Provider Identifier
1164475794
Registry record updated May 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X
License
2025 Issued in ME
Practice address
149 North St
Waterville, ME 04901-4974
Phone
(207) 861-5101
Fax
(207) 872-4341
NPI assigned
May 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2025 ME
Family Medicine Physician 207Q00000X 0530213 KS
Neuromusculoskeletal Medicine & OMM Physician 204D00000X 2025 ME Primary

Addresses

Primary practice location

149 North St
Waterville, ME 04901-4974

Mailing address

149 North St
Waterville, ME 04901-4974
Phone (207) 861-5101

Other identifiers 2

IdentifierTypeStateIssuer
100457760BMedicaidKS
432706399MedicaidME

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
I20071018000289 ME Practitioner - Osteopathic Manipulative MedicinePractitioner - Family Practice 5890735195 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Osteopathic Manipulative MedicineAlso: Family Practice
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mainegeneral Medical CenterGroup PAC ID 1254245715, 554 clinicians

Practice addresses (Care Compare)

149 N St
Waterville, ME 04901
Phone (207) 872-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.22 of 100Reported as group
Quality
75.39
Promoting interoperability
84
Improvement activities
40
Cost
75.32

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2025MEMDNeuromusculoskeletal Medicine & OMM Physician
0530213KSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mainegeneral Medical Center CurrentSince Aug 29, 2007 Accepting new patients
Mainegeneral Medical Center CurrentSince Aug 29, 2007 Accepting new patients

Locations

10 Water St
Ste 202
Waterville, ME 04901
Phone (207) 873-9846

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

Interoperability endpoints

  • Direct secure messaging: marksutherland@mgh.allscriptsdirect.net

Organizations & group practices 2

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": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559260800000",
    "number": "1164475794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 NORTH ST",
            "city": "WATERVILLE",
            "state": "ME",
            "postal_code": "049014974",
            "telephone_number": "207-861-5101",
            "fax_number": "207-872-4341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 NORTH ST",
            "city": "WATERVILLE",
            "state": "ME",
            "postal_code": "049014974",
            "telephone_number": "207-861-5101",
            "fax_number": "207-872-4341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTHERLAND",
        "first_name": "MARK",
        "middle_name": "ERIN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2019-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "2025",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "0530213",
            "primary": false
        },
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "ME",
            "license": "2025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100457760B",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "432706399",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterville, ME

Sources for this page

Verify at the official NPI Registry.