NPIMap

Individual provider Active NPI

Catherine Gisele Boucher-Cornelio, DO

  • Family Medicine Physician
  • Saco, ME
National Provider Identifier
1447571864
Registry record updated Aug 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OT013764 Issued in ME
Practice address
13 Industrial Park Rd
Saco, ME 04072
Phone
(207) 294-3561
NPI assigned
Jun 21, 2010
Last updated
Aug 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OT013764 ME Primary

Addresses

Primary practice location

13 Industrial Park Rd
Saco, ME 04072

Mailing address

13 Industrial Park Rd
Saco, ME 04072-1804
Phone (207) 283-8800

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
I20130930000037 ME Practitioner - Family PracticePractitioner - Osteopathic Manipulative Medicine 4486890589 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Osteopathic Manipulative Medicine
Education
University of New England, College of Osteo Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

13 Industrial Park Rd
Saco, ME 04072-1804
Phone (207) 283-8800

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

25 A June St
Sanford, ME 04073-2642

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OT013764MEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Jan 1, 2019 Accepting new patients
Mainehealth CurrentSince Jan 1, 2019 Accepting new patients
Mainehealth CurrentSince Aug 26, 2018 Accepting new patients
Mainehealth CurrentSince Aug 26, 2018 Accepting new patients
Mainehealth Current Accepting new patients
Mainehealth Family Medicine Past Accepting new patients

Locations

1 Medical Dr
Biddeford, ME 04005
Phone (207) 283-7000

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

13 Industrial Park Rd
Saco, ME 04072
Phone (207) 283-8800

Interoperability endpoints

  • Direct secure messaging: cbouchercornelio226188@direct.mmc.mainehealth.org

Organizations & group practices 6

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.

Hospital & facility affiliations 37

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

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1277078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534464000000",
    "number": "1447571864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 INDUSTRIAL PARK RD",
            "city": "SACO",
            "state": "ME",
            "postal_code": "040721804",
            "telephone_number": "207-283-8800",
            "fax_number": "207-294-3561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 INDUSTRIAL PARK RD",
            "city": "SACO",
            "state": "ME",
            "postal_code": "04072",
            "telephone_number": "207-294-3561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCHER-CORNELIO",
        "first_name": "CATHERINE",
        "middle_name": "GISELE",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-21",
        "last_updated": "2018-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "OT013764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saco, ME

Sources for this page

Verify at the official NPI Registry.