Active NPI
Elissa J Charbonneau, DO
- Physical Medicine & Rehabilitation Physician
- Yarmouth, ME
National Provider Identifier
1700870201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 1399
- Practice address
- 24 Hawthorne Circle
Yarmouth, ME 04096-8337 - Phone
- (207) 851-1724
- NPI assigned
- Sep 12, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 1399 | ME | Primary |
Addresses
Primary practice location
24 Hawthorne Circle
Yarmouth, ME 04096-8337
Mailing address
301 US Route One
Building C
Scarborough, ME 04074-9701
Phone (207) 396-8600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 218640049 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1399 | ME | MD | Physical Medicine & Rehabilitation Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orthopaedic Surgery Center | Past | Accepting new patients | |
| Encompass Health Rehabilitation Hospital of York, LLC | Past | Accepting new patients | |
| Orthopaedic Associates of Portland, PA | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Orthopaedic Surgery Physician
- Portland, ME
- NPI 1295729531
-
- Ambulatory Surgical Clinic/Center
- Portland, ME
- NPI 1578502068
-
- Rehabilitation Hospital
- York, PA
- NPI 1811960537
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297987200000",
"number": "1700870201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 US ROUTE ONE",
"address_2": "BUILDING C",
"city": "SCARBOROUGH",
"state": "ME",
"postal_code": "040749701",
"telephone_number": "207-396-8600",
"fax_number": "207-396-8632"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 HAWTHORNE CIRCLE",
"city": "YARMOUTH",
"state": "ME",
"postal_code": "040968337",
"telephone_number": "207-851-1724"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHARBONNEAU",
"first_name": "ELISSA",
"middle_name": "J",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-09-12",
"last_updated": "2011-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "ME",
"license": "1399",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "218640049",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Yarmouth, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.