Active NPI
Jean Henderson Tibbetts, MD
- Specialist
- Bangor, ME
National Provider Identifier
1225020480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 011702
- Practice address
- 417 State St
Suite 230
Bangor, ME 04401-6630 - Phone
- (207) 947-1291
- Fax
- (207) 947-9241
- NPI assigned
- Aug 15, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 011702 | ME | Primary |
Addresses
Primary practice location
417 State St
Suite 230
Bangor, ME 04401-6630
Mailing address
417 State St
Suite 230
Bangor, ME 04401-6630
Phone (207) 947-1291
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 221710099 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011702 | ME | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Norumbega Medical Specialists, LTD | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Health Service Clinic/Center
- Brewer, ME
- NPI 1780821140
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1390953600000",
"number": "1225020480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "417 STATE ST",
"address_2": "SUITE 230",
"city": "BANGOR",
"state": "ME",
"postal_code": "044016630",
"telephone_number": "207-947-1291",
"fax_number": "207-947-9241"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "417 STATE ST",
"address_2": "SUITE 230",
"city": "BANGOR",
"state": "ME",
"postal_code": "044016630",
"telephone_number": "207-947-1291",
"fax_number": "207-947-9241"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIBBETTS",
"first_name": "JEAN",
"middle_name": "HENDERSON",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-15",
"last_updated": "2014-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "ME",
"license": "011702",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "221710099",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.