NPIMap

Organization Active NPI

Maine Comprehensive Pain Management, PC

  • Medical Specialty Clinic/Center
  • Scarborough, ME
National Provider Identifier
1467928705
Registry record updated Sep 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
MAINE COMPREHENSIVE PAIN MANAGEMENT, PC
Practice address
400 Enterprise Dr Ste 101
Scarborough, ME 04074-7662
Phone
(207) 289-6726
Fax
(207) 289-1219
NPI assigned
Oct 14, 2018
Last updated
Sep 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2019

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

Authorized official

Name
Terence Kernan Gray, DONPI 1588604698
Title
President
Phone
(860) 944-4708

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine Physician 208VP0000X
Interventional Pain Medicine Physician 208VP0014X
Medical Specialty Clinic/Center 261QM2500X Primary

Addresses

Primary practice location

400 Enterprise Dr Ste 101
Scarborough, ME 04074-7662

Mailing address

400 Enterprise Dr Ste 101
Scarborough, ME 04074-7662
Phone (207) 289-6726

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190227001165 ME Part B Supplier - Clinic/Group Practice 8123367687 Receives reassigned benefits from 4 practitioners
Practice locations: Scarborough, ME
O20191010000281 ME DME Supplier - Physician - Unknown Physician Specialty 8123367687 Practice locations: Scarborough, ME

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
20D2160499Maine Comprehensive Pain Management, PC400 Enterprise Dr, Ste 101, Scarborough, ME 04074Certificate of waiverJan 10, 2027

National Provider Directory

National Provider Directory

Locations

400 Enterprise Dr
#101
Scarborough, ME 04074

400 Enterprise Dr
Ste 101
Scarborough, ME 04074
Phone (207) 289-6726

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/18448/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1539475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569369600000",
    "number": "1467928705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 ENTERPRISE DR STE 101",
            "city": "SCARBOROUGH",
            "state": "ME",
            "postal_code": "040747662",
            "telephone_number": "207-289-6726",
            "fax_number": "207-289-1219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 ENTERPRISE DR STE 101",
            "city": "SCARBOROUGH",
            "state": "ME",
            "postal_code": "040747662",
            "telephone_number": "207-289-6726",
            "fax_number": "207-289-1219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINE COMPREHENSIVE PAIN MANAGEMENT, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-14",
        "last_updated": "2019-09-25",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "TERENCE",
        "authorized_official_middle_name": "KERNAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-944-4708",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scarborough, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.