NPIMap

Organization Active NPI

Convenientmd LLC

  • Primary Care Clinic/Center
  • Portland, ME
National Provider Identifier
1609694207
Registry record updated Oct 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
CONVENIENTMD LLC
Practice address
211 Marginal Way
Portland, ME 04101-2467
Phone
(207) 544-9355
Fax
(207) 544-7756
NPI assigned
Oct 1, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2024

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

Authorized official

Name
Gareth Dickens
Title
Ceo, Managing Employee
Phone
(603) 501-0863

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

211 Marginal Way
Portland, ME 04101-2467

Mailing address

360 US Highway 1 Byp Unit 102
Portsmouth, NH 03801-7105
Phone (603) 410-6700

Other names 1

  • ConvenientMD Virtual Care Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180220000535 ME Part B Supplier - Clinic/Group Practice 2062667033 Receives reassigned benefits from 9 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ellsworth, ME; Saco, ME; Sanford, ME; Westbrook, ME; Portland, ME; Bangor, ME; Augusta, ME; Auburn, ME…

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Convenientmd LLC29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

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

View all 28

Locations

211 Marginal Way
Portland, ME 04101
Phone (207) 517-3838

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1727740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727740800000",
    "number": "1609694207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 US HIGHWAY 1 BYP UNIT 102",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038017105",
            "telephone_number": "603-410-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 MARGINAL WAY",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041012467",
            "telephone_number": "207-544-9355",
            "fax_number": "207-544-7756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONVENIENTMD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-01",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A",
        "authorized_official_last_name": "DICKENS",
        "authorized_official_first_name": "GARETH",
        "authorized_official_title_or_position": "CEO, MANAGING EMPLOYEE",
        "authorized_official_telephone_number": "603-501-0863"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ConvenientMD Virtual Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Oct 1, 2024; 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.