NPIMap

Organization Active NPI

Vantage Healthcare Inc

  • Internal Medicine Physician
  • Kittery, ME
National Provider Identifier
1386474625
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
VANTAGE HEALTHCARE INC
Practice address
9 Lewis Rd
Kittery, ME 03904-5410
Phone
(781) 867-2050
NPI assigned
Aug 2, 2024
Last updated
Sep 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

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

Authorized official

Name
Vishal KuchacullaNPI 1386837342
Title
Owner
Phone
(781) 867-2050

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
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

9 Lewis Rd
Kittery, ME 03904-5410

Mailing address

45 Dan Rd
Canton, MA 02021-2852
Phone (781) 867-2050

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240925003407 ME Part B Supplier - Clinic/Group Practice 0042751430 Receives reassigned benefits from 8 practitioners
Practice locations: North Berwick, ME; South Portland, ME; Scarborough, ME; Kittery, ME; Kennebunk, ME; Canton, ME; Biddeford, ME

National Provider Directory

National Provider Directory

Locations

25 Country Club Dr
South Portland, ME 04106
Phone (207) 292-0281

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1722556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726444800000",
    "number": "1386474625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 DAN RD",
            "city": "CANTON",
            "state": "MA",
            "postal_code": "020212852",
            "telephone_number": "781-867-2050",
            "fax_number": "781-867-2040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 LEWIS RD",
            "city": "KITTERY",
            "state": "ME",
            "postal_code": "039045410",
            "telephone_number": "781-867-2050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANTAGE HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-02",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A",
        "authorized_official_last_name": "KUCHACULLA",
        "authorized_official_first_name": "VISHAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "781-867-2050"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kittery, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.