Kolleen Cannon Dougherty, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

MD15174 Issued in ME

Practice address

22 Bramhall St
Portland, ME 04102-3134

Phone

(207) 662-2526

NPI assigned

Nov 14, 2006

Last updated

Oct 27, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kolleen Cannon Former name

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Anesthesiology

Education

Columbia University College of Physicians and Surgeons, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Central Maine Medical CenterGroup PAC ID 2567379563, 344 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Central Maine Medical Center Hospital, Lewiston, ME, CCN 200024

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/4517c430-03bf-4e32-b324-1387cc4e73f3/

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.

• Central Maine Medical Center

  • General Acute Care Hospital
  • Lewiston, ME
  • NPI 1689653487
  Medicare reassignment Care Compare group NPD
• Bridgton Hospital

  • Critical Access Hospital
  • Bridgton, ME
  • NPI 1154370153
  Medicare reassignment NPD
• Rumford Hospital

  • Critical Access Hospital
  • Rumford, ME
  • NPI 1205991122
  Medicare reassignment NPD
• Bridgton Hospital

  dba Bridgton Hospital Swing Bed

  • Medicare Defined Swing Bed Hospital Unit
  • Bridgton, ME
  • NPI 1477691467
  NPD
• Central Maine Medical Center

  dba CMMC Specialty Pharmacy

  • Community/Retail Pharmacy
  • Lewiston, ME
  • NPI 1033874458
  NPD
• Central Maine Medical Center

  dba Maine Urgent Care

  • Urgent Care Clinic/Center
  • Lewiston, ME
  • NPI 1063136786
  NPD
• Rumford Hospital

  dba Rumford Hospital Swingbed

  • Medicare Defined Swing Bed Hospital Unit
  • Rumford, ME
  • NPI 1982742482
  NPD

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

• Central Maine Medical Center

  • General Acute Care Hospital
  • Lewiston, ME
  • NPI 1689653487
  Care Compare affiliation

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445904000000",
    "number": "1427120708",
    "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": "22 BRAMHALL ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023134",
            "telephone_number": "207-662-2526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "KOLLEEN",
        "middle_name": "CANNON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2015-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "ME",
            "license": "MD15174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KOLLEEN",
            "last_name": "CANNON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• John Henry Dorsey Jr., DPM
• Kallie M Dorsey, LMSW-CC
• Anuja Doshi, DDS, MS
• Andrea Doucette, NP
• William Carl Doucette, MD
• Elizabeth Doughty, PT, DPT
• Katie Doughty
• Chelsea Douglass, NNP
• Kaylee Dow
• Mary Dowd, MD

• Anesthesiology Physician in Portland, ME
• Providers in Portland, ME by specialty
• Anesthesiology Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.