Michel Juan Rondon Vidal, M.D.

Primary specialty

Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X

License

14095 Issued in NH

Practice address

330 Borthwick Ave
Ste 111
Portsmouth, NH 03801-4174

Phone

(603) 294-4424

Fax

(603) 319-1603

NPI assigned

Aug 1, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 7

Addresses

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• State of Maine

  • Psychiatric Hospital
  • Bangor, ME
  • NPI 1699776146
  Medicare reassignment NPD
• State of Maine

  • Psychiatric Hospital
  • Augusta, ME
  • NPI 1053319566
  NPD

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

{
    "created_epoch": "1217548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644364800000",
    "number": "1447416128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 BORTHWICK AVE",
            "address_2": "STE 111",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038014174",
            "telephone_number": "603-294-4424",
            "fax_number": "603-319-1603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 BORTHWICK AVE",
            "address_2": "STE 111",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038014174",
            "telephone_number": "603-294-4424",
            "fax_number": "603-319-1603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RONDON VIDAL",
        "first_name": "MICHEL",
        "middle_name": "JUAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-01",
        "last_updated": "2022-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "FL",
            "license": "ME 110923",
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "CA",
            "license": "C56143",
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "NH",
            "license": "14095",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "C56143",
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "ME",
            "license": "MD18951",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "MD449053",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "268558-1",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "michel.rondonvidal@hca6.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "330 Borthwick Ave",
            "address_2": "STE 111",
            "city": "Portsmouth",
            "state": "NH",
            "country_code": "US",
            "postal_code": "038014174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kristina Alyse Rogers Scherr, PMHNP-BC, CNM, MSN
• Clare Ruth Rogers, M.D.
• Julie Davis Rollins, MOT OTR/L
• Khara L Roman, ATC
• Angelica Marie Romeu, DPT
• Thomas Jacob Rooney
• Amy Rosania, DMD, MSCD
• David Rosania, DMD, MS
• Kelsey Marie Rose, DMD
• Ian M Rosenthal, MD

• Geriatric Psychiatry Physician in Portsmouth, NH
• Providers in Portsmouth, NH by specialty
• Geriatric Psychiatry Physician in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.