Individual provider Active NPI

Debra E. Riley

  • Speech-Language Pathologist
  • Portland, ME
National Provider Identifier
1710109533
Registry record updated Sep 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SP1589 Issued in ME
Practice address
43 Baxter Blvd
Portland, ME 04101-1823
Phone
(207) 874-1065
Fax
(207) 874-1068
NPI assigned
May 2, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SP1589 ME Primary

Addresses

Primary practice location

43 Baxter Blvd
Portland, ME 04101-1823

Mailing address

43 Baxter Blvd
Portland, ME 04101-1823
Phone (207) 874-1065

Other identifiers 1

IdentifierTypeStateIssuer
431973199MedicaidME

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
SP1589MEMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Hearing and Speech Center, Inc. Speech-Language Pathologist PastSince Jan 12, 2006 Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221436800000",
    "number": "1710109533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 BAXTER BLVD",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041011823",
            "telephone_number": "207-874-1065",
            "fax_number": "207-874-1068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 BAXTER BLVD",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041011823",
            "telephone_number": "207-874-1065",
            "fax_number": "207-874-1068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RILEY",
        "first_name": "DEBRA",
        "middle_name": "E.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2008-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ME",
            "license": "SP1589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "431973199",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.