Active NPI
Mary Lee Connolly
- Home Health Aide
- South Portland, ME
National Provider Identifier
1477044238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- Practice address
- 724 Sawyer St
South Portland, ME 04106-4619 - Phone
- (207) 749-7942
- NPI assigned
- May 28, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | AA | ME | |
| Home Health Aide | 374U00000X | Primary |
Addresses
Primary practice location
724 Sawyer St
South Portland, ME 04106-4619
Mailing address
724 Sawyer St
South Portland, ME 04106-4619
Phone (207) 749-7942
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477044238 | Other | ME | OPTUM VA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | PORTLAND | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AA | ME | MD | Home Health Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607299200000",
"number": "1477044238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "724 SAWYER ST",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041064619",
"telephone_number": "207-749-7942"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "724 SAWYER ST",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041064619",
"telephone_number": "207-749-7942"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNOLLY",
"first_name": "MARY",
"middle_name": "LEE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-05-28",
"last_updated": "2020-12-07",
"certification_date": "2020-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Home Health Aide",
"state": "ME",
"license": "AA",
"primary": false
},
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTUM VA",
"identifier": "1477044238",
"state": "ME"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "PORTLAND",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "724 Sawyer St",
"city": "South Portland",
"state": "ME",
"country_code": "US",
"postal_code": "041064619",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in South Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.