Active NPI
Mainehealth
Doing business as MMC Pediatric Urology
- Pediatric Urology Physician
- Portland, ME
National Provider Identifier
1457540486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Urology Physician
- Legal business name
- MAINEHEALTH
- Doing business as
- MMC Pediatric Urology
- Practice address
- 22 Bramhall St
Portland, ME 04102 - Phone
- (207) 662-2179
- NPI assigned
- Oct 16, 2007
- Last updated
- May 11, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Lugene Anthony Inzana
- Title
- Associate Cfo
- Phone
- (207) 662-3538
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Urology Physician | 2088P0231X | Primary |
Addresses
Primary practice location
22 Bramhall St
Portland, ME 04102
Mailing address
301 US Route 1
Building C
Scarborough, ME 04074-7609
Phone (207) 396-8600
Other names 1
- MMC Pediatric Urology
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME
Enrollment records 3
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040331000351 | ME | Part B Supplier - Clinic/Group Practice | 7517860588 |
Receives reassigned benefits from 46 practitioners 12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Farmington, ME; Portland, ME; Scarborough, ME |
| O20040701000166 | ME | Part B Supplier - Clinic/Group Practice | 7517860588 |
Receives reassigned benefits from 3,561 practitioners 38 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
| O20071116000569 | ME | Part A Provider - Hospital | 7517860588 |
35 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1457540486. Details of each certification follow.
Hospital certification: CCN 200009
- Legal name
- MAINEHEALTH
- Doing business as
- MAINEHEALTH MAINE MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Feb 27, 2019
- Beds
- 606
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation
- Enrollment address
- 22 Bramhall St
Portland, ME 41023134 - Hospital subgroups
- General, Acute care
Related certifications (CCN) 1
Facilities connected through Provider of Services related, parent or unit certification numbers.
Other NPIs on the same Medicare enrollment 53
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba MMP Orthopedics ( Div of Orthopedic Trauma & Fracture Care)
- Orthopaedic Trauma Physician
- Portland, ME
- NPI 1003113127
O20040331000351, O20071116000569
-
dba Maine Hemophilia and Thrombosis Center
- General Acute Care Hospital
- Scarborough, ME
- NPI 1053647024
O20040701000166, O20071116000569
-
- Maternal & Fetal Medicine Physician
- Portland, ME
- NPI 1063726891
O20040701000166, O20071116000569
-
dba Maine Medical Center Infectious Disease
- Infectious Disease Physician
- Portland, ME
- NPI 1073701157
O20040331000351, O20040701000166, O20071116000569
-
dba MMC Oral Surgery
- Oral & Maxillofacial Surgery (D.M.D.)
- Portland, ME
- NPI 1073702288
O20040331000351
-
dba Geriatric Consults
- Geriatric Medicine (Internal Medicine) Physician
- Portland, ME
- NPI 1164610242
O20040331000351, O20040701000166, O20071116000569
-
dba SMHC Physician Services
- Multi-Specialty Clinic/Center
- Biddeford, ME
- NPI 1215417019
O20040701000166
-
dba MaineHealth Virtual Care Virtual Quick Care
- Urgent Care Clinic/Center
- Portland, ME
- NPI 1265251540
O20040701000166
-
dba MMC Pediatric Intensive Care Unit
- Pediatric Critical Care Medicine Physician
- Portland, ME
- NPI 1265536817
O20040331000351, O20040701000166, O20071116000569
-
dba MaineHealth Behavioral Health
- Community/Behavioral Health Agency
- Portland, ME
- NPI 1265912067
O20040701000166
Care Compare: Hospital
Medicare Care Compare- Listed as
- Mainehealth Maine Medical Center
- Overall star rating
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 33
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Nancy a Hasenfus | Corporate Director | Jan 1, 2019 | |
| Brett Loffredo | Corporate Director | Jan 1, 2019 | |
| Brian H Noyes | Corporate Director | Oct 1, 2016 | |
| Dawn M Tutt | W-2 Managing Employee | Dec 30, 2013 | |
| Marie J McCarthy | Corporate Director | Oct 1, 2016 | |
| Matthew Chin | Corporate Director | Apr 1, 2025 | |
| Katherine B Coster | Corporate Director | Oct 1, 2016 | |
| Beth Kelsch | Corporate Officer | Apr 1, 2025 | |
| Robert Hunter | Corporate Officer | Dec 1, 2025 | |
| Ann W Bresnahan | Corporate Director | Oct 1, 2023 | |
| Christopher Cimino | Corporate Director | Oct 1, 2025 | |
| Andrew T Mueller | Corporate Officer | Jul 1, 2021 | |
| Lisa T Beaule | Corporate Director | Jan 1, 2019 | |
| Charles Richard Bayman | Corporate Officer | Dec 1, 2025 | |
| Corporate Director | Dec 1, 2025 | ||
| Christopher C Coon | Corporate Officer | Jan 1, 2016 | |
| Kelly a Elkins | Corporate Officer | Jan 1, 2022 | |
| Jennifer Kent | Corporate Director | Oct 1, 2025 | |
| Peter W Wood | Corporate Director | Jan 1, 2022 | |
| Thomas J Ryan | Corporate Director | Jan 1, 2019 | |
| David J Kumaki | Corporate Director | Jan 1, 2019 | |
| Quincy Hentzel | Corporate Director | Apr 1, 2025 | |
| Morris L Fisher | Corporate Director | Jun 1, 2013 | |
| Leslie Clinton Boothby | Corporate Director | Jan 1, 2019 | |
| Kathleen Herlihy | Corporate Director | Jan 1, 2019 | |
| Mainehealth Services | 5% Or Greater Direct Ownership Interest | Jan 1, 2019 | 100% |
| Operational/Managerial Control | Jan 1, 2019 | 100% | |
| Linda M. Terry | Corporate Director | Jan 1, 2022 | |
| Peter C Manning | Corporate Director | Jan 1, 2019 | |
| Alissa Chasse | W-2 Managing Employee | Jan 1, 2025 | |
| Daniel L Loiselle | Corporate Director | Jan 1, 2019 | |
| Kelly Champney | Corporate Officer | Jun 1, 2026 | |
| Matthew P Orlando | Corporate Director | Oct 1, 2024 | |
| Stuart H Watson | Corporate Director | Jan 1, 2022 | |
| Amanda Rand | Corporate Director | Jan 1, 2023 |
Owners & managing parties with NPI records 5
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Obstetrics & Gynecology Physician
- Biddeford, ME
- NPI 1902977077
Corporate Director
-
- Interventional Cardiology Physician
- Scarborough, ME
- NPI 1326019563
Corporate Director
Practitioners & affiliated clinicians
Practitioners 69
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Hospitalist Physician
- Biddeford, ME
- NPI 1679034136
-
- Physician Assistant
- Portland, ME
- NPI 1093352718
-
- Physician Assistant
- Windham, ME
- NPI 1225636947
-
- Hospitalist Physician
- Lewiston, ME
- NPI 1932587722
-
- Hospitalist Physician
- Portland, ME
- NPI 1457678518
-
- Nurse Practitioner
- Scarborough, ME
- NPI 1831837152
-
- Acute Care Nurse Practitioner
- Brunswick, ME
- NPI 1740075076
-
- Physician Assistant
- Biddeford, ME
- NPI 1518508001
-
- Internal Medicine Physician
- Damariscotta, ME
- NPI 1831365311
-
- Acute Care Nurse Practitioner
- Portland, ME
- NPI 1407455793
-
- Psychiatric/Mental Health Nurse Practitioner
- Sanford, ME
- NPI 1033713110
-
- Nurse Practitioner
- Westbrook, ME
- NPI 1700435807
Affiliated clinicians 2,518
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192492800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1589155200000",
"number": "1457540486",
"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": "040747609",
"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": "22 BRAMHALL ST",
"city": "PORTLAND",
"state": "ME",
"postal_code": "04102",
"telephone_number": "207-662-2179"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MAINEHEALTH",
"organizational_subpart": "NO",
"enumeration_date": "2007-10-16",
"last_updated": "2020-05-11",
"certification_date": "2020-05-11",
"status": "A",
"authorized_official_last_name": "INZANA",
"authorized_official_first_name": "LUGENE",
"authorized_official_middle_name": "ANTHONY",
"authorized_official_title_or_position": "ASSOCIATE CFO",
"authorized_official_telephone_number": "207-662-3538"
},
"taxonomies": [
{
"code": "2088P0231X",
"taxonomy_group": "",
"desc": "Urology, Pediatric Urology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "MMC Pediatric Urology",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "MMC Pediatric Urology",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Portland, ME
- Mainehealth
- Mainehealth
- Mainehealth (MMC Cardiology)
- Mainehealth (MMP Surgical Care)
- Mainehealth
- Mainehealth (Maine Medical Partners Pediatric Specialty Care)
- Mainehealth (MaineHealth Medical Group-Primary Care)
- Mainehealth (Angel Ambulance)
- Mainehealth (MaineHealth Maine Medical Center)
- Mainehealth (Maine Medical Partners Specialty Care)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- 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.