NPIMap

Organization Active NPI

Portland Gastroenterology Associates P.a.

  • Gastroenterology Physician
  • Portland, ME
National Provider Identifier
1508087289
Registry record updated Feb 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
PORTLAND GASTROENTEROLOGY ASSOCIATES P.A.
Practice address
161 Marginal Way
Portland, ME 04101
Phone
(207) 773-7964
Fax
(207) 773-9073
NPI assigned
May 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2023

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

Authorized official

Name
Melissa Gousse
Title
Practice Administrator
Phone
(207) 773-7964

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

161 Marginal Way
Portland, ME 04101

Mailing address

161 Marginal Way
Portland, ME 04101-2438
Phone (207) 773-7964

Other identifiers 1

IdentifierTypeStateIssuer
111280000MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040630000866 ME Part B Supplier - Clinic/Group Practice 5193702967 Receives reassigned benefits from 34 practitioners
Practice locations: Portland, ME

National Provider Directory

National Provider Directory

Locations

1200 Congress St
Ste 300
Portland, ME 04102
Phone (207) 773-7964

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675382400000",
    "number": "1508087289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 MARGINAL WAY",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041012438",
            "telephone_number": "207-773-7964",
            "fax_number": "207-773-9073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 MARGINAL WAY",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04101",
            "telephone_number": "207-773-7964",
            "fax_number": "207-773-9073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND GASTROENTEROLOGY ASSOCIATES P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2023-02-03",
        "certification_date": "2023-02-03",
        "status": "A",
        "authorized_official_last_name": "GOUSSE",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "207-773-7964"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111280000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.