Organization Active NPI

Wellness for Women PLLC

  • Gynecology Physician
  • Kennebunk, ME
National Provider Identifier
1205495793
Registry record updated Oct 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
Legal business name
WELLNESS FOR WOMEN PLLC
Practice address
50 Portland Rd Ste 4
Kennebunk, ME 04043-6789
Phone
(207) 502-7400
Fax
(207) 569-0012
NPI assigned
Jun 10, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2019

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

Authorized official

Name
Lisa Dries, DONPI 1992998553
Title
Owner/Provider
Phone
(207) 467-5588

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207VG0400X Primary

Addresses

Primary practice location

50 Portland Rd Ste 4
Kennebunk, ME 04043-6789

Mailing address

94C Whitten Hill Rd
Kennebunkport, ME 04046-5114
Phone (207) 467-5588

Other identifiers 1

IdentifierTypeStateIssuer
433002499MedicaidME

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191016002530 ME Part B Supplier - Clinic/Group Practice 5799016184 Receives reassigned benefits from 2 practitioners
Practice locations: Kennebunk, ME

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
20D2167566Wellness for Women50 Portland Road, Kennebunk, ME 04043Provider-performed microscopyJun 10, 2027

National Provider Directory

National Provider Directory

Locations

50 Portland Rd
Ste 4
Kennebunk, ME 04043
Phone (207) 502-7400

5 Fletcher St
Kennebunk, ME 04043

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/19754/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1560124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571702400000",
    "number": "1205495793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "94C WHITTEN HILL RD",
            "city": "KENNEBUNKPORT",
            "state": "ME",
            "postal_code": "040465114",
            "telephone_number": "207-467-5588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 PORTLAND RD STE 4",
            "city": "KENNEBUNK",
            "state": "ME",
            "postal_code": "040436789",
            "telephone_number": "207-502-7400",
            "fax_number": "207-569-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS FOR WOMEN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-10",
        "last_updated": "2019-10-22",
        "status": "A",
        "authorized_official_last_name": "DRIES",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "207-467-5588",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "433002499",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennebunk, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.