NPIMap

Individual provider Active NPI

Mary J Brennan, APRN-BC

  • Acute Care Nurse Practitioner
  • Portland, ME
National Provider Identifier
1699782623
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
CNP211468 Issued in ME
Practice address
10 Andover Rd
Portland, ME 04102-1954
Phone
(207) 761-6642
NPI assigned
Aug 2, 2006
Last updated
Dec 21, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X CNP211468 ME Primary
Acute Care Nurse Practitioner 363LA2100X 047934-23 NH
Hospitalist Physician 208M00000X 047934-23 NH

Addresses

Primary practice location

10 Andover Rd
Portland, ME 04102-1954

Mailing address

10 Andover Rd
Portland, ME 04102-1954
Phone (207) 761-6642

Other practice location 1

333 Borthwick Ave
Portsmouth, NH 03801-7128
Phone (603) 334-2039

Other identifiers 2

IdentifierTypeStateIssuer
432951999MedicaidME
30347119MedicaidNH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address DaLaguex@mainehealth.org Direct

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
I20220210000817 ME Practitioner - Nurse Practitioner 8729971908 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 885-9905

55 Spring St
Scarborough, ME 04074-8926
Phone (207) 303-1000

Hospital & facility affiliations

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
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
002862CTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Feb 14, 2022 Accepting new patients
Maine Medical Partners Current Accepting new patients
Maine Medical Partners CurrentSince Feb 14, 2022 Accepting new patients
Mainehealth CurrentSince Feb 14, 2022 Accepting new patients
Mainehealth Current Accepting new patients
Appledore Medical Group Inc Hospitalist Past Accepting new patients
NP Care, LLC Past Accepting new patients
Appledore Medical Group, Inc Past Accepting new patients

Locations

10 Andover Rd
Portland, ME 04102
Phone (207) 761-6642

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

887 Congress St
Ste 210
Portland, ME 04102
Phone (207) 774-2381

Interoperability endpoints

  • Direct secure messaging: dalaguex@mainehealth.org
  • Direct secure messaging: mbrennan462101@direct.mmc.mainehealth.org

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1699782623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 ANDOVER RD",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041021954",
            "telephone_number": "207-761-6642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 ANDOVER RD",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041021954",
            "telephone_number": "207-761-6642"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "333 Borthwick Ave",
            "address_purpose": "LOCATION",
            "city": "Portsmouth",
            "state": "NH",
            "postal_code": "038017128",
            "country_code": "US",
            "telephone_number": "603-334-2039",
            "fax_number": "603-433-5180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRENNAN",
        "first_name": "MARY",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "APRN-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-02",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "ME",
            "license": "CNP211468",
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NH",
            "license": "047934-23",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NH",
            "license": "047934-23",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "432951999",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30347119",
            "state": "NH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "DaLaguex@mainehealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "10 Andover Rd",
            "city": "Portland",
            "state": "ME",
            "country_code": "US",
            "postal_code": "041021954",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.