NPIMap

Organization Active NPI

Eyecare Medical Group

  • Ambulatory Surgical Clinic/Center
  • Portland, ME
National Provider Identifier
1376599381
Registry record updated Dec 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
36395 Issued in ME
Legal business name
EYECARE MEDICAL GROUP
Practice address
53 Sewall Street
Portland, ME 04102-2625
Phone
(207) 828-2020
Fax
(207) 773-7034
NPI assigned
May 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2021

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

Authorized official

Name
Lynn Shorty, RN, CMPE
Title
Chief Operating Officer
Phone
(207) 791-8234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 36395 ME Primary

Addresses

Primary practice location

53 Sewall Street
Portland, ME 04102-2625

Mailing address

53 Sewall Street
Portland, ME 04102-2625
Phone (207) 828-2020

Other identifiers 1

IdentifierTypeStateIssuer
109280100MedicaidME

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080407000589 ME Part B Supplier - Ambulatory Surgical Center 7517995129 Receives reassigned benefits from 7 practitioners
Practice locations: Portland, ME

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Eyecare Medical GroupCCN 20C0001002
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Eyecare Medical Group3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 7

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": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639699200000",
    "number": "1376599381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 SEWALL STREET",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022625",
            "telephone_number": "207-828-2020",
            "fax_number": "207-773-7034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 SEWALL STREET",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022625",
            "telephone_number": "207-828-2020",
            "fax_number": "207-773-7034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECARE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A",
        "authorized_official_last_name": "SHORTY",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "207-791-8234",
        "authorized_official_credential": "RN, CMPE"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "ME",
            "license": "36395",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "109280100",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; 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.