Individual provider Active NPI

Edward P. Nicholas, M.D.

  • Diagnostic Radiology Physician
  • Bangor, ME
National Provider Identifier
1629299003
Registry record updated Nov 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD19238 Issued in ME
Practice address
489 State St
Bangor, ME 04401-6616
Phone
(207) 973-8150
NPI assigned
May 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MD19238 ME Primary

Addresses

Primary practice location

489 State St
Bangor, ME 04401-6616

Mailing address

324 Gannett Dr Ste 200
South Portland, ME 04106-3266
Phone (207) 482-7800

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120730000151 ME Practitioner - Diagnostic Radiology 7315116498 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Rutgers New Jersey Medical School, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spectrum Healthcare Partners PAGroup PAC ID 7618871245, 305 clinicians

Practice addresses (Care Compare)

111 Balsam Rd
Bangor, ME 04401-2544
Phone (207) 662-4735

200 Somerset St
Millinocket, ME 04462-1258
Phone (207) 723-3380

360 Broadway
Bangor, ME 04401-3979
Phone (207) 262-1682

489 State St
Bangor, ME 04401-6616
Phone (207) 973-8305

50 Union St
Ellsworth, ME 04605-1534
Phone (207) 664-5311

900 Broadway
Bangor, ME 04401-1900
Phone (207) 262-1841

Hospital & facility affiliations

  • Northern Light Eastern Maine Medical Center Hospital, Bangor, ME, CCN 200033
  • Northern Light Maine Coast Hospital Hospital, Ellsworth, ME, CCN 200050
  • Northern Light Blue Hill Memorial Hospital Hospital, Blue Hill, ME, CCN 201300
  • St Joseph Hospital Hospital, Bangor, ME, CCN 200001
  • Millinocket Regional Hospital Hospital, Millinocket, ME, CCN 201307

Merit-based Incentive Payment System (MIPS)

Final score
97.93 of 100Reported as apm
Quality
83.31
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum Healthcare Partners, P.a. CurrentSince Jul 1, 2012 Accepting new patients
Spectrum Healthcare Partners, PA Diagnostic Radiology CurrentSince Jul 1, 2012 Accepting new patients
Insight-Premier Health LLC Diagnostic Radiology CurrentSince Dec 6, 2019 Accepting new patients

Locations

489 State St
Bangor, ME 04401
Phone (207) 973-8837

489 State St
#100
Bangor, ME 04401
Phone (207) 945-4680

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

324 Gannett Dr
Ste 200
South Portland, ME 04106
Phone (207) 482-7861

Organizations & group practices 3

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446422400000",
    "number": "1629299003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 GANNETT DR STE 200",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041063266",
            "telephone_number": "207-482-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "489 STATE ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016616",
            "telephone_number": "207-973-8150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLAS",
        "first_name": "EDWARD",
        "middle_name": "P.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2015-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ME",
            "license": "MD19238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.