NPIMap

Individual provider Active NPI

Marc Daniel Kimball, M.D.

  • Family Medicine Physician
  • Westbrook, ME
National Provider Identifier
1467815274
Registry record updated Jun 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD23253 Issued in ME
Practice address
1 Harnois Ave
Westbrook, ME 04092-4392
Phone
(207) 661-3400
NPI assigned
Mar 30, 2016
Last updated
Jun 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X ME
Family Medicine Physician 207Q00000X MD23253 ME Primary

Addresses

Primary practice location

1 Harnois Ave
Westbrook, ME 04092-4392

Mailing address

1 Harnois Ave
Westbrook, ME 04092-4392
Phone (207) 661-3400

Other practice location 1

272 Congress St
Portland, ME 04101-3637
Phone (207) 874-2466

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
I20191108001186 ME Practitioner - Family Practice 6608162953 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Tufts University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MainehealthGroup PAC ID 7517860588, shared by 31 NPIs, 2,616 clinicians

Practice addresses (Care Compare)

272 Congress St
Portland, ME 04101-3637
Phone (207) 874-2466

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD23253MEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Oct 4, 2019 Accepting new patients
Maine Medical Partners Current Accepting new patients
Maine Medical Partners CurrentSince Jul 1, 2021 Accepting new patients
Maine Medical Partners Family Medicine CurrentSince Jul 1, 2021 Accepting new patients
Maine Medical Partners CurrentSince Jul 25, 2020 Accepting new patients
Maine Medical Partners Family Medicine CurrentSince Jul 25, 2020 Accepting new patients
Maine Medical Partners Current Accepting new patients
Mainehealth Family Medicine CurrentSince Oct 4, 2019 Accepting new patients
Mainehealth CurrentSince Oct 4, 2019 Accepting new patients
Mainehealth Current Accepting new patients
Maine Medical Partners CurrentSince Jul 1, 2021 Accepting new patients

Locations

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

272 Congress St
Portland, ME 04101
Phone (207) 874-2466

5 Bucknam Rd
Portland, ME 04105
Phone (207) 781-1500

96 Campus Dr
Ste 2B
Scarborough, ME 04074
Phone (207) 883-3491

1 Harnois Ave
Westbrook, ME 04092
Phone (207) 662-1340

1 Harnois Ave
Ste 1A
Westbrook, ME 04092
Phone (207) 662-1360

1 Harnois Ave
Ste 2
Westbrook, ME 04092
Phone (207) 661-3400

584 Roosevelt Trl
Windham, ME 04062
Phone (207) 892-3216

Interoperability endpoints

  • Direct secure messaging: mkimball140155@direct.mmc.mainehealth.org

Organizations & group practices 11

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 39

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

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1459296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623801600000",
    "number": "1467815274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HARNOIS AVE",
            "city": "WESTBROOK",
            "state": "ME",
            "postal_code": "040924392",
            "telephone_number": "207-661-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HARNOIS AVE",
            "city": "WESTBROOK",
            "state": "ME",
            "postal_code": "040924392",
            "telephone_number": "207-661-3400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "272 Congress St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "ME",
            "postal_code": "041013637",
            "country_code": "US",
            "telephone_number": "207-874-2466",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIMBALL",
        "first_name": "MARC",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-30",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "ME",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "MD23253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Westbrook, ME

Sources for this page

Verify at the official NPI Registry.