Portland Endoscopy Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PORTLAND ENDOSCOPY CENTER

Practice address

161 Marginal Way
Portland, ME 04101-2438

Phone

(207) 773-7964

Fax

(207) 773-9073

NPI assigned

Oct 4, 2006

Last updated

Feb 14, 2025By the provider in NPPES

Organization subpart

No

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

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ME

Enrollment records 1

Listed as

Portland Endoscopy CenterCCN 20C0001003

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Practitioners 20

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.

• Noemi Baffy, MD

  • Gastroenterology Physician
  • Portland, ME
  • NPI 1164710075
  NPD (past)
• Fernando Herbert Calmet, M.D.

  • Gastroenterology Physician
  • Portland, ME
  • NPI 1659690956
  NPD (past)
• Melanie F Connors, FNP

  • Family Nurse Practitioner
  • Portland, ME
  • NPI 1497881833
  NPD (past)
• Vicki L. Cook, NP-C

  • Nurse Practitioner
  • Portland, ME
  • NPI 1548820384
  NPD (past)
• Joshua A Goldman, M.D.

  • Gastroenterology Physician
  • Portland, ME
  • NPI 1558396523
  NPD (past)
• Matthew Drew Grunwald, M.D.

  • Gastroenterology Physician
  • Portland, ME
  • NPI 1689061954
  NPD (past)
• Bryan Hayes

  • Family Nurse Practitioner
  • Portland, ME
  • NPI 1679958946
  NPD (past)
• Tara K Hieger, NP

  • Nurse Practitioner
  • Portland, ME
  • NPI 1679681456
  NPD (past)
• Kate Forssell Kennedy, MD

  • Gastroenterology Physician
  • Portland, ME
  • NPI 1134325806
  NPD (past)
• Leeanne S Mather, APRN

  • Family Nurse Practitioner
  • Portland, ME
  • NPI 1669722013
  NPD (past)
• Thalia Mayes, M.D.

  • Gastroenterology Physician
  • Portland, ME
  • NPI 1033126826
  NPD (past)
• Gordon A Millspaugh III, M.D.

  • Gastroenterology Physician
  • Portland, ME
  • NPI 1114025988
  NPD (past)

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739491200000",
    "number": "1558456459",
    "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": "041012438",
            "telephone_number": "207-773-7964",
            "fax_number": "207-773-9073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTLAND ENDOSCOPY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2025-02-14",
        "certification_date": "2025-02-14",
        "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": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "118790000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Portland Community Health Center
• Portland Community Health Center (Greater Portland Health)
• Portland Community Health Center (Greater Portland Health)
• Portland Dental Health Care
• Portland Disc Center PLLC (Absolute Health Chiropractic and Massage)
• Portland Family Dental
• Portland Foot & Ankle, PA
• Portland Gastroenterology Associates P.a.
• Portland Housing Authority
• Portland Humanistic Therapy LLC

• Ambulatory Surgical Clinic/Center in Portland, ME
• Providers in Portland, ME by specialty
• Ambulatory Surgical Clinic/Center in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2025; 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.