Individual provider Active NPI

Mary Kathleen Jennings, MD

  • Pediatrics Physician
  • Portland, ME
National Provider Identifier
1679741839
Registry record updated Mar 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
016582 Issued in ME
Practice address
84 Marginal Way
Suite 1000
Portland, ME 04101-1392
Phone
(207) 774-4092
Fax
(207) 523-8596
NPI assigned
Feb 11, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 016582 ME Primary

Addresses

Primary practice location

84 Marginal Way
Suite 1000
Portland, ME 04101-1392

Mailing address

100 Gannett Drive
Suite C
South Portland, ME 04106
Phone (207) 347-2947

Other identifiers 1

IdentifierTypeStateIssuer
30209656MedicaidNH

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
I20100929001377 ME Practitioner - Pediatric Medicine 4981720786 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD10603RIMDInternal Medicine Physician
016582MEMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Intermed, PA Pediatrics CurrentSince Jul 1, 2018 Accepting new patients
Intermed, PA Pediatrics CurrentSince Sep 12, 2018 Accepting new patients

Locations

84 Marginal Way
Ste 800
Portland, ME 04101
Phone (207) 774-5816

84 Marginal Way
Portland, ME 04101
Phone (207) 774-5816

84 Marginal Way
Ste 1000
Portland, ME 04101
Phone (207) 347-2898

100 Foden Rd
South Portland, ME 04106
Phone (207) 828-1122

100 Gannett Dr
Ste C
South Portland, ME 04106
Phone (207) 523-3649

100 Foden Rd
Ste 203
South Portland, ME 04106
Phone (207) 874-1489

100 Foden Rd
Ste W-100
South Portland, ME 04106
Phone (207) 523-3900

Interoperability endpoints

  • Direct secure messaging: mary.jennings@int.eclinicaldirectplus.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1202688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774396800000",
    "number": "1679741839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 GANNETT DRIVE",
            "address_2": "SUITE C",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "04106",
            "telephone_number": "207-347-2947",
            "fax_number": "207-874-2317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "84 MARGINAL WAY",
            "address_2": "SUITE 1000",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041011392",
            "telephone_number": "207-774-4092",
            "fax_number": "207-523-8596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENNINGS",
        "first_name": "MARY",
        "middle_name": "KATHLEEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-11",
        "last_updated": "2026-03-25",
        "certification_date": "2026-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ME",
            "license": "016582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30209656",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.