NPIMap

Organization Active NPI

State of Maine

  • Community/Behavioral Health Agency
  • Augusta, ME
National Provider Identifier
1386887008
Registry record updated Jun 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
526359 Issued in ME
Legal business name
STATE OF MAINE
Practice address
5 Caldwell Rd
Augusta, ME 04330-0011
Phone
(207) 287-5747
Fax
(207) 287-5755
NPI assigned
Apr 10, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2019

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

Authorized official

Name
Jennifer Gagnon
Title
Financial Manager
Phone
(207) 624-4675

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 526359 ME Primary

Addresses

Primary practice location

5 Caldwell Rd
Augusta, ME 04330-0011

Mailing address

109 Capitol Street SHS#11 Reimbursement Unit
Augusta, ME 04333-0011
Phone (207) 287-7418

Other identifiers 1

IdentifierTypeStateIssuer
135911607MedicaidME

Other names 1

  • Act Team Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040610001611 ME Part B Supplier - Clinic/Group Practice 7517875131 Receives reassigned benefits from 99 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Augusta, ME; Bangor, ME

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

47 Water St
Fl 1
Hallowell, ME 04347

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1239321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560470400000",
    "number": "1386887008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 CAPITOL STREET SHS#11 REIMBURSEMENT UNIT",
            "city": "AUGUSTA",
            "state": "ME",
            "postal_code": "043330011",
            "telephone_number": "207-287-7418",
            "fax_number": "207-287-5755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 CALDWELL RD",
            "city": "AUGUSTA",
            "state": "ME",
            "postal_code": "043300011",
            "telephone_number": "207-287-5747",
            "fax_number": "207-287-5755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MAINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-10",
        "last_updated": "2019-06-14",
        "status": "A",
        "authorized_official_last_name": "GAGNON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "FINANCIAL MANAGER",
        "authorized_official_telephone_number": "207-624-4675"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "ME",
            "license": "526359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135911607",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Act Team",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Act Team",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Augusta, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2019; 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.