NPIMap

Individual provider Active NPI

Candice M Dersch, MD

  • Obstetrics & Gynecology Physician
  • Portland, ME
National Provider Identifier
1437358157
Registry record updated Aug 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
MD18808 Issued in ME
Practice address
887 Congress St
Suite 200
Portland, ME 04102-3166
Phone
(207) 771-5549
Fax
(207) 771-7834
NPI assigned
Jul 12, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X MD18808 ME Primary

Addresses

Primary practice location

887 Congress St
Suite 200
Portland, ME 04102-3166

Mailing address

301 US Route 1
Building C
Scarborough, ME 04074-9701
Phone (207) 396-8600

Other identifiers 1

IdentifierTypeStateIssuer
32000563MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110812000471 ME Practitioner - Obstetrics/Gynecology 3971772690 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Medical College of Wisconsin, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 885-9905

887 Congress St
Suite 200
Portland, ME 04102-3166
Phone (207) 771-5549

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.93 of 100Reported as apm
Quality
83.31
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD18808MEMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maine Medical Partners CurrentSince Aug 8, 2011 Accepting new patients
Mainehealth CurrentSince Sep 8, 2011 Accepting new patients
Mainehealth CurrentSince Sep 8, 2011 Accepting new patients
Maine Medical Partners Obstetrics & Gynecology CurrentSince Aug 8, 2011 Accepting new patients
Maine Medical Partners CurrentSince Apr 10, 2020 Accepting new patients
Mainehealth Current Accepting new patients
Mainehealth Past Accepting new patients

Locations

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

887 Congress St
Ste 200
Portland, ME 04102
Phone (207) 771-5549

1 Harnois Ave
Ste 2
Westbrook, ME 04092
Phone (207) 661-3400

584 Roosevelt Trl
Windham, ME 04062
Phone (207) 892-3216

Interoperability endpoints

  • Direct secure messaging: cdersch3263@direct.mmc.mainehealth.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1184198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343952000000",
    "number": "1437358157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 US ROUTE 1",
            "address_2": "BUILDING C",
            "city": "SCARBOROUGH",
            "state": "ME",
            "postal_code": "040749701",
            "telephone_number": "207-396-8600",
            "fax_number": "207-396-8632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "887 CONGRESS ST",
            "address_2": "SUITE 200",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023166",
            "telephone_number": "207-771-5549",
            "fax_number": "207-771-7834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERSCH",
        "first_name": "CANDICE",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-12",
        "last_updated": "2012-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "ME",
            "license": "MD18808",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32000563",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.