NPIMap

Individual provider Active NPI

John R. Hatzenbuehler, MD

  • Family Medicine Physician
  • South Portland, ME
National Provider Identifier
1699844365
Registry record updated Oct 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD17466 Issued in ME
Practice address
100 Foden Rd, East
Suite 200
South Portland, ME 04106
Phone
(207) 523-8500
Fax
(207) 523-8591
NPI assigned
Nov 7, 2006
Last updated
Oct 29, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD17466 ME Primary
Sports Medicine (Family Medicine) Physician 207QS0010X MD17466 ME

Addresses

Primary practice location

100 Foden Rd, East
Suite 200
South Portland, ME 04106

Mailing address

100 Gannett Drive
Suite C
South Portland, ME 04106
Phone (207) 828-0361

Other identifiers 2

IdentifierTypeStateIssuer
30207627MedicaidNH
432651599MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20170719003637 ID Practitioner - Family Practice 5395819627 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Washington School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic - Wood River LLCGroup PAC ID 3173783818, 66 clinicians

Practice addresses (Care Compare)

100 Hospital Dr
Ketchum, ID 83340

100 Hospital Dr
Ketchum, ID 83340-9998

1450 Aviation Dr
Hailey, ID 83333-8785

191 5TH St W
Ketchum, ID 83340-9998
Phone (208) 725-2171

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic - Wood River LLC Family Medicine CurrentSince Jun 19, 2017 Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2235

1450 Aviation Dr
Ste 100
Hailey, ID 83333
Phone (208) 788-3434

Interoperability endpoints

  • Direct secure messaging: jhatzenbuehler87985@direct.slhs.org

Organizations & group practices 1

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 5

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": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446076800000",
    "number": "1699844365",
    "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": "207-828-0361",
            "fax_number": "207-874-1483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 FODEN RD, EAST",
            "address_2": "SUITE 200",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "04106",
            "telephone_number": "207-523-8500",
            "fax_number": "207-523-8591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATZENBUEHLER",
        "first_name": "JOHN",
        "middle_name": "R.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2015-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "MD17466",
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "ME",
            "license": "MD17466",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30207627",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "432651599",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Portland, ME

Sources for this page

Verify at the official NPI Registry.