Michael J. Bedecs, D.O.
Individual provider Active NPI Family Medicine Physician · Portland, ME
NPI 1164569547 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1164569547
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 904 (ME)
- Practice address
- 1375 Congress St
Portland, ME 04102-2118 - Phone
- (207) 409-8500
- Fax
- (207) 780-1055
- NPI assigned
- Feb 1, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141113001122 | ME | Order and Referring Only - Family Practice |
3173533015 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 904 | ME | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Vein Center, LLC | Past |
Accepting new patients | |
| Advanced Wound Care Center, LLC | Past |
Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/CBACBA
- https://api.platform.athenahealth.com/4271/brand/1/csg/21/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 904 | ME | Yes |
Addresses
Primary practice location
1375 Congress St
Portland, ME 04102-2118
Mailing address
1375 Congress St
Portland, ME 04102-2118
Phone (207) 409-8500
Other providers in Portland, ME
- Colin Joseph Bechtel
- Lloyd F Beckett
- Stephen V Beckett
- Lauren Taylor Beckwith
- Grace Elisabeth Bedard
- Jeffrey C Bedrosian
- Christopher James Beeler
- Whitney H Beeler
- Normand L Begin
- Behavioral Health Resources of Maine Inc
All providers in Portland, ME · Family Medicine Physician in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.