NPIMap

Organization Active NPI

Sunbury Primary Care, P.a.

  • Family Medicine Physician
  • Bangor, ME
National Provider Identifier
1508939398
Registry record updated Jan 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SUNBURY PRIMARY CARE, P.A.
Practice address
133 Corporate Dr
Suite 1
Bangor, ME 04401-4312
Phone
(207) 947-9900
Fax
(207) 992-9292
NPI assigned
Nov 17, 2006
Organization subpart
Yes
Parent organization
SUNBURY PRIMARY CARE, P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 21, 2009

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

Authorized official

Name
David L Savell
Title
Chief Executive Officer
Phone
(207) 942-7650

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

133 Corporate Dr
Suite 1
Bangor, ME 04401-4312

Mailing address

PO Box 921
Bangor, ME 04402-0921
Phone (207) 990-0864

Other identifiers 1

IdentifierTypeStateIssuer
124740004MedicaidME

Other names 1

  • Bangor Family Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Sunbury Primary Care PA11 organizations share this tax ID, including this one
Part of
Sunbury Primary Care PA

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

133 Corporate Dr
Ste 1
Bangor, ME 04401
Phone (207) 947-9900

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 54

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

View all 54

NPI Registry JSON

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232496000000",
    "number": "1508939398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 921",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044020921",
            "telephone_number": "207-990-0864",
            "fax_number": "207-990-5586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 CORPORATE DR",
            "address_2": "SUITE 1",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014312",
            "telephone_number": "207-947-9900",
            "fax_number": "207-992-9292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNBURY PRIMARY CARE, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUNBURY PRIMARY CARE, P.A.",
        "enumeration_date": "2006-11-17",
        "last_updated": "2009-01-21",
        "status": "A",
        "authorized_official_last_name": "SAVELL",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "207-942-7650"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124740004",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bangor Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bangor, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.