NPIMap

Individual provider Active NPI

Michael Henry, M.D.

  • Anesthesiology Physician
  • Portland, ME
National Provider Identifier
1649625500
Registry record updated Aug 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD26140 Issued in ME
Practice address
22 Bramhall St
Portland, ME 04102-3134
Phone
(207) 662-0111
NPI assigned
Apr 28, 2016
Reactivated
Sep 14, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X A168636 CA
Pediatric Anesthesiology Physician 207LP3000X A168636 CA
Anesthesiology Physician 207L00000X MD26140 ME Primary

Addresses

Primary practice location

22 Bramhall St
Portland, ME 04102-3134

Mailing address

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

Other practice location 1

24451 Health Center Dr
Laguna Hills, CA 92653-3689
Phone (949) 452-7200

Other identifiers 1

IdentifierTypeStateIssuer
1649625500MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220824003675 ME Practitioner - Anesthesiology 3779878087 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Tufts University School of Medicine, 2016
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)

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 662-2526

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A168636CAMDAnesthesiology Physician
MD26140MEMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum Healthcare Partners, P.a. Anesthesiology CurrentSince Oct 1, 2022 Accepting new patients
Spectrum Healthcare Partners, P.a. CurrentSince Oct 1, 2022 Accepting new patients

Locations

35 Miles St
Damariscotta, ME 04543
Phone (207) 563-1234

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

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

Interoperability endpoints

  • Direct secure messaging: mhenry75896@direct.mmc.mainehealth.org

Organizations & group practices 2

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 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1461801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660089600000",
    "number": "1649625500",
    "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": "22 BRAMHALL ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023134",
            "telephone_number": "207-662-0111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24451 Health Center Dr",
            "address_purpose": "LOCATION",
            "city": "Laguna Hills",
            "state": "CA",
            "postal_code": "926533689",
            "country_code": "US",
            "telephone_number": "949-452-7200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENRY",
        "first_name": "MICHAEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-28",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "deactivation_date": "2021-09-03",
        "reactivation_date": "2021-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A168636",
            "primary": false
        },
        {
            "code": "207LP3000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pediatric Anesthesiology",
            "state": "CA",
            "license": "A168636",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "ME",
            "license": "MD26140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649625500",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.