Michael C Tavares, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

CNP241426 Issued in ME

Practice address

181 Corporate Dr
Bangor, ME 04401-4314

Phone

(207) 992-2636

NPI assigned

Aug 18, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

University of South Alabama College of Medicine, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Penobscot Community Health CenterGroup PAC ID 0143212670, 135 clinicians

Impact Health Psych PCGroup PAC ID 6204248149, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Penobscot Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Bangor, ME
  • NPI 1427169010
  Medicare reassignment Care Compare group NPD
• Impact Health Psych PC

  • Psychiatric/Mental Health Nurse Practitioner
  • Orange, CT
  • NPI 1730781022

  ME

  Medicare reassignment Care Compare group
• Penobscot Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Bangor, ME
  • NPI 1083259410
  NPD

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

{
    "created_epoch": "1660780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1558089276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1599",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "181 CORPORATE DR",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014314",
            "telephone_number": "207-992-2636"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1221 W Lakeview Ave",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325011836",
            "country_code": "US",
            "telephone_number": "850-469-3500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6119 Hilburn Rd",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325046218",
            "country_code": "US",
            "telephone_number": "850-602-8467",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAVARES",
        "first_name": "MICHAEL",
        "middle_name": "C",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-18",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN11022135",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ME",
            "license": "CNP241426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronald David Tapley, PHARM.D.
• Deborah Lee Taplin, LCPC-C
• Jude I Tardy, P.A.
• Sheri Marie Tarr, FNP
• Renee Tash
• April Marie Taylor, LCPC
• Ashley Nichole Taylor, LMSW-CC
• Corey Michael Taylor
• Courtney Lee Taylor, AGACNP
• Eric C Taylor, LCSW

• Psychiatric/Mental Health Nurse Practitioner in Bangor, ME
• Providers in Bangor, ME by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.