NPIMap

Individual provider Active NPI

Guillermo Olivos, M.D.

  • Diagnostic Radiology Physician
  • Bangor, ME
National Provider Identifier
1245284892
Registry record updated Nov 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD16817 Issued in ME
Practice address
489 State St
Bangor, ME 04401-6616
Phone
(207) 973-8150
NPI assigned
May 19, 2006
Last updated
Nov 3, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Medicine Physician 207U00000X MD16817 ME
Diagnostic Radiology Physician 2085R0202X MD16817 ME Primary

Addresses

Primary practice location

489 State St
Bangor, ME 04401-6616

Mailing address

324 Gannett Dr Ste 200
South Portland, ME 04106-3266
Phone (207) 482-7800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050706000416 ME Practitioner - Diagnostic Radiology 7315902343 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Uniformed Services Uhs Fe Hebert School of Med, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spectrum Healthcare Partners PAGroup PAC ID 7618871245, 305 clinicians

Practice addresses (Care Compare)

200 Somerset St
Millinocket, ME 04462-1258
Phone (207) 723-3380

360 Broadway
Bangor, ME 04401-3979
Phone (207) 262-1682

489 State St
Bangor, ME 04401-6616
Phone (207) 973-8305

50 Union St
Ellsworth, ME 04605-1534
Phone (207) 664-5311

738 Kenduskeag Ave
Bangor, ME 04401-2908
Phone (207) 662-4735

900 Broadway
Bangor, ME 04401-1900
Phone (207) 262-1841

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.93 of 100Reported as apm
Quality
83.31
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum Healthcare Partners, P.a. CurrentSince Jul 1, 2005 Accepting new patients
Spectrum Healthcare Partners, PA Diagnostic Radiology CurrentSince Jul 1, 2005 Accepting new patients
Insight-Premier Health LLC Diagnostic Radiology CurrentSince Dec 6, 2019 Accepting new patients
Dimensions Health Corporation Diagnostic Radiology Past Accepting new patients
Community Radiology Associates Inc Nuclear Medicine Past Accepting new patients
American Radiology Associates, P.a. Nuclear Medicine Past Accepting new patients
Spectrum Medical Group, P.a. Diagnostic Radiology Past Accepting new patients
Spectrum Healthcare Partners, PA Diagnostic Radiology Past Accepting new patients
American Radiology Associates, P.a. Nuclear Medicine Past Accepting new patients

Locations

360 Broadway
Bangor, ME 04401
Phone (207) 262-1703

489 State St
Bangor, ME 04401
Phone (207) 973-8837

489 State St
#100
Bangor, ME 04401
Phone (207) 945-4680

324 Gannett Dr
Ste 200
South Portland, ME 04106
Phone (207) 482-7861

200 Kennedy Memorial Dr
Waterville, ME 04901
Phone (207) 861-3000

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446508800000",
    "number": "1245284892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 GANNETT DR STE 200",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041063266",
            "telephone_number": "207-482-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "489 STATE ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016616",
            "telephone_number": "207-973-8150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVOS",
        "first_name": "GUILLERMO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2015-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": "ME",
            "license": "MD16817",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ME",
            "license": "MD16817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.