Andre Benoit Jr., M.D.
Individual provider Active NPI Family Medicine Physician · Southwest Harbor, ME
NPI 1679516181 · NPPES record last updated Oct 28, 2015
Key facts
- NPI
- 1679516181
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 009835 (ME)
- Practice address
- 45 Herrick Rd
Southwest Harbor, ME 04679-4433 - Phone
- (207) 244-5513
- Fax
- (207) 664-5515
- NPI assigned
- Jun 13, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080917000237 | ME | Practitioner - Family Practice | 3870660889 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009835 | ME | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Martin'S Point Health Care, Inc. | Family Medicine | Current |
Accepting new patients |
Locations
6 Farley Rd
Mere Point, ME 04011
Phone (207) 725-8079
331 Veranda St
Portland, ME 04103
Phone (207) 774-5801
Interoperability endpoints
- https://api.platform.athenahealth.com/5857/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 009835 | ME | Yes |
Addresses
Primary practice location
45 Herrick Rd
Southwest Harbor, ME 04679-4433
Mailing address
50 Union St
Ellsworth, ME 04605-1534
Phone (207) 664-5513
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 111770199 | Medicaid | ME |
Other providers in Southwest Harbor, ME
- Acadia Family Center
- Thomas A Adams
- Margaret Beaulac
- Betsey Bess
- Carroll Drug Store Inc
- Carroll Drug Store Inc
- Hilary C Chermak
- Bartholomew Clayton
All providers in Southwest Harbor, ME · Family Medicine Physician in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 28, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.