Active NPI
Mary Ellen Lee
- Developmental Disabilities Clinic/Center
- Brewer, ME
National Provider Identifier
1285963041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Disabilities Clinic/Center
- Practice address
- 727 N Main St
Brewer, ME 04412-1260 - Phone
- (207) 907-4160
- Fax
- (207) 907-4160
- NPI assigned
- Dec 8, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Developmental Disabilities Clinic/Center | 261QD1600X | Primary |
Addresses
Primary practice location
727 N Main St
Brewer, ME 04412-1260
Mailing address
727 N Main St
Brewer, ME 04412-1260
Phone (207) 907-4160
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3002923 | Other | ME | MAINECARE PROVIDER LICENSE NUMBER |
| 432802900 | Other | ME | MAINECARE BILLING NUMBER |
| VC0000112845 | Other | ME | MAINECARE VENDOR NUMBER |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1260230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260230400000",
"number": "1285963041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "727 N MAIN ST",
"city": "BREWER",
"state": "ME",
"postal_code": "044121260",
"telephone_number": "207-907-4160",
"fax_number": "207-907-4160"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "727 N MAIN ST",
"city": "BREWER",
"state": "ME",
"postal_code": "044121260",
"telephone_number": "207-907-4160",
"fax_number": "207-907-4160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "MARY",
"middle_name": "ELLEN",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-12-08",
"last_updated": "2009-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "261QD1600X",
"taxonomy_group": "",
"desc": "Clinic/Center, Developmental Disabilities",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAINECARE PROVIDER LICENSE NUMBER",
"identifier": "3002923",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAINECARE BILLING NUMBER",
"identifier": "432802900",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAINECARE VENDOR NUMBER",
"identifier": "VC0000112845",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brewer, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.