Mainehealth
Organization Active NPI Pediatric Urology Physician · Portland, ME
NPI 1457540486 · NPPES record last updated May 11, 2020
Key facts
- NPI
- 1457540486
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatric Urology Physician 2088P0231X
- Legal business name
- MAINEHEALTH
- Practice address
- 22 Bramhall St
Portland, ME 04102 - Phone
- (207) 662-2179
- NPI assigned
- Oct 16, 2007
- Organization subpart
- No
Authorized official
- Name
- Lugene Anthony Inzana
- Title
- Associate Cfo
- Phone
- (207) 662-3538
Owners & managing parties with NPI records 5
-
Lisa T Beaule, MD
-
Brett M Loffredo, MD
-
Peter C Manning, MD
-
Thomas J Ryan Jr., M.D.
Other NPIs on the same Medicare enrollment 53
Related certifications (CCN) 1
Practitioners 69
-
Ashley Rose Anderson, PA-C
-
Jason Blake, DO
-
Sarah M Bray, MD
-
Virginia Marion Campbell, AGACNP-BC
-
Nikki Cavallo, PA-C
-
Catherine E. Cavanaugh, D.O.
-
Olivia Lea Clement, PMHNP
-
Brittany Ann Diaz, CNM
-
Anya Dissen, RDN, LD
-
David T. Frost, M.D.
-
Daniel Jacob Goodman, D.O.
-
Samir A Haydar, DO
-
Tayla Marie Hewins, PMHNP
-
Jennifer L. Hillstrom, M.D.
-
Ian David Jester, MD
-
Blair Johnson, MHS, PA-C
Affiliated clinicians 2,518
-
George E Abboud, MD
-
Ahmad Abed Elnoor, M.D.
-
Joselyn M Abernethy, MSN, ACNP-BC
-
Philip Abraham, M.D.
-
Joshua Abrams, PA-C
-
Haley Estabrook Acker, PA-C
-
Niall Adams, MB BCH BAO
-
Todd M Adams, MD
-
Virginia JS Adams, CRNA
-
Katharine E Addicott, FNP
-
Gregory S Adey, M.D.
-
Mary Elizabeth Adorisio, PA-C
-
Maxwell Afari, MD
-
Mats Agren, M.D.
-
Bilal R Ahmad, M.D.
Medicare Care Compare: Hospital
- Listed as
- Mainehealth Maine Medical Center
- Overall star rating
- ★★★★☆ 4 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in ME
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 · Non-profit
- Enrollment address
- 22 Bramhall St
Portland, ME 41023134 - Hospital subgroups
- General, Acute care
All disclosed owners & managing parties 33
| 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 |
Medicare enrollment records
| 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 |
National Provider Directory
Locations
159 Main St
#2
Norway, ME 04268
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Urology Physician |
2088P0231X | Yes |
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
- MMC Pediatric Urology
Other providers in Portland, ME
- Mainehealth
- Mainehealth
- Mainehealth
- Mainehealth
- Mainehealth
- Mainehealth
- Mainehealth
- Mainehealth
- Mainehealth
- Mainehealth
All providers in Portland, ME · Pediatric Urology Physician in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.