NPIMap

Individual provider Active NPI

Meghan R Mamula, DO

  • Family Medicine Physician
  • Brewer, ME
National Provider Identifier
1457456733
Registry record updated May 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO1691 Issued in ME
Practice address
735 Wilson St
Brewer, ME 04412-1000
Phone
(207) 992-2601
Fax
(207) 989-2280
NPI assigned
Sep 13, 2006
Last updated
May 5, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2021

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 DO1691 ME Primary

Addresses

Primary practice location

735 Wilson St
Brewer, ME 04412-1000

Mailing address

PO Box 1599
Bangor, ME 04402-1599
Phone (207) 945-5247

Other identifiers 1

IdentifierTypeStateIssuer
267430099MedicaidME

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
I20080418000190 ME Practitioner - Family Practice 6204914062 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Penobscot Community Health CenterGroup PAC ID 0143212670, 135 clinicians

Practice addresses (Care Compare)

1012 Union St
Bangor, ME 04401-3058

1068 Union St
Bangor, ME 04401-3016
Phone (207) 404-8181

735 Wilson St
Brewer, ME 04412-1000
Phone (207) 989-1567

992 Union St
Bangor, ME 04401-3057

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO1691MEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Penobscot Community Health Center CurrentSince Sep 11, 2000 Accepting new patients
Penobscot Community Health Center Current Accepting new patients
Penobscot Community Health Center CurrentSince Sep 11, 2000 Accepting new patients
Bangor Family Health Care Family Medicine Past Accepting new patients
Penobscot Community Health Center Past Accepting new patients
Bangor Healthcare Family Medicine Past Accepting new patients

Locations

1012 Union St
Ste 1
Bangor, ME 04401
Phone 2079455247407

1012 Union St
Ste 3
Bangor, ME 04401
Phone (207) 404-8040

735 Wilson St
Brewer, ME 04412
Phone (207) 989-1567

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 4

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

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620172800000",
    "number": "1457456733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1599",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021599",
            "telephone_number": "207-945-5247",
            "fax_number": "207-947-0435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 WILSON ST",
            "city": "BREWER",
            "state": "ME",
            "postal_code": "044121000",
            "telephone_number": "207-992-2601",
            "fax_number": "207-989-2280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMULA",
        "first_name": "MEGHAN",
        "middle_name": "R",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-13",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "DO1691",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "267430099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brewer, ME

Sources for this page

Verify at the official NPI Registry.