Active NPI
Mainehealth
Doing business as Maine Medical Partners Urology
- Urology Physician
- South Portland, ME
National Provider Identifier
1710297494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- Legal business name
- MAINEHEALTH
- Doing business as
- Maine Medical Partners Urology
- Practice address
- 100 Brickhill Ave
South Portland, ME 04106 - Phone
- (207) 773-1728
- Fax
- (207) 772-4062
- NPI assigned
- Oct 15, 2010
- Organization subpart
- Yes
- Parent organization
- MAINE MEDICAL CENTER
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Lugene Anthony Inzana
- Title
- Associate Cfo
- Phone
- (207) 662-3538
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | Primary | ||
| General Acute Care Hospital | 282N00000X | 37563 | ME | |
| Physician Assistant | 363A00000X | |||
| Family Nurse Practitioner | 363LF0000X |
Addresses
Primary practice location
100 Brickhill Ave
South Portland, ME 04106
Mailing address
22 Bramhall St
Portland, ME 04102-3134
Phone (207) 662-6562
Other names 1
- Maine Medical Partners Urology
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Cobius Healthcare Solutions |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071116000569 | ME | Part A Provider - Hospital | 7517860588 |
35 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1710297494. Details of each certification follow.
Hospital certification: CCN 200009
- Legal name
- MAINEHEALTH
- Doing business as
- MAINEHEALTH MAINE MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Feb 27, 2019
- Beds
- 606
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation
- Enrollment address
- 22 Bramhall St
Portland, ME 41023134 - Hospital subgroups
- General, Acute care
Related certifications (CCN) 1
Facilities connected through Provider of Services related, parent or unit certification numbers.
Other NPIs on the same Medicare enrollment 35
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba MMP Orthopedics ( Div of Orthopedic Trauma & Fracture Care)
- Orthopaedic Trauma Physician
- Portland, ME
- NPI 1003113127
O20071116000569
-
dba Maine Hemophilia and Thrombosis Center
- General Acute Care Hospital
- Scarborough, ME
- NPI 1053647024
O20071116000569
-
dba Maine Medical Center Infectious Disease
- Infectious Disease Physician
- Portland, ME
- NPI 1073701157
O20071116000569
-
dba Geriatric Consults
- Geriatric Medicine (Internal Medicine) Physician
- Portland, ME
- NPI 1164610242
O20071116000569
-
dba MMC Pediatric Intensive Care Unit
- Pediatric Critical Care Medicine Physician
- Portland, ME
- NPI 1265536817
O20071116000569
-
dba Maine Medical Partners Endocrinlogy & Diabetes
- Endocrinology, Diabetes & Metabolism Physician
- Scarborough, ME
- NPI 1356651038
O20071116000569
-
dba MMC Pediatric Urology
- Pediatric Urology Physician
- Portland, ME
- NPI 1457540486
O20071116000569
-
dba Maine Medical Partners Pediatric Specialty Care
- Gastroenterology Physician
- Portland, ME
- NPI 1477850592
O20071116000569
Care Compare: Hospital
Medicare Care Compare- Listed as
- Mainehealth Maine Medical Center
- Overall star rating
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
National Provider Directory
National Provider Directory- Part of
- Maine Medical Assoc
Locations
22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179
100 Brickhill Ave
South Portland, ME 04106
Phone (207) 773-1728
Ownership & related parties
All disclosed owners & managing parties 33
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Nancy a Hasenfus | Corporate Director | Jan 1, 2019 | |
| Brett Loffredo | Corporate Director | Jan 1, 2019 | |
| Brian H Noyes | Corporate Director | Oct 1, 2016 | |
| Dawn M Tutt | W-2 Managing Employee | Dec 30, 2013 | |
| Marie J McCarthy | Corporate Director | Oct 1, 2016 | |
| Matthew Chin | Corporate Director | Apr 1, 2025 | |
| Katherine B Coster | Corporate Director | Oct 1, 2016 | |
| Beth Kelsch | Corporate Officer | Apr 1, 2025 | |
| Robert Hunter | Corporate Officer | Dec 1, 2025 | |
| Ann W Bresnahan | Corporate Director | Oct 1, 2023 | |
| Christopher Cimino | Corporate Director | Oct 1, 2025 | |
| Andrew T Mueller | Corporate Officer | Jul 1, 2021 | |
| Lisa T Beaule | Corporate Director | Jan 1, 2019 | |
| Charles Richard Bayman | Corporate Officer | Dec 1, 2025 | |
| Corporate Director | Dec 1, 2025 | ||
| Christopher C Coon | Corporate Officer | Jan 1, 2016 | |
| Kelly a Elkins | Corporate Officer | Jan 1, 2022 | |
| Jennifer Kent | Corporate Director | Oct 1, 2025 | |
| Peter W Wood | Corporate Director | Jan 1, 2022 | |
| Thomas J Ryan | Corporate Director | Jan 1, 2019 | |
| David J Kumaki | Corporate Director | Jan 1, 2019 | |
| Quincy Hentzel | Corporate Director | Apr 1, 2025 | |
| Morris L Fisher | Corporate Director | Jun 1, 2013 | |
| Leslie Clinton Boothby | Corporate Director | Jan 1, 2019 | |
| Kathleen Herlihy | Corporate Director | Jan 1, 2019 | |
| Mainehealth Services | 5% Or Greater Direct Ownership Interest | Jan 1, 2019 | 100% |
| Operational/Managerial Control | Jan 1, 2019 | 100% | |
| Linda M. Terry | Corporate Director | Jan 1, 2022 | |
| Peter C Manning | Corporate Director | Jan 1, 2019 | |
| Alissa Chasse | W-2 Managing Employee | Jan 1, 2025 | |
| Daniel L Loiselle | Corporate Director | Jan 1, 2019 | |
| Kelly Champney | Corporate Officer | Jun 1, 2026 | |
| Matthew P Orlando | Corporate Director | Oct 1, 2024 | |
| Stuart H Watson | Corporate Director | Jan 1, 2022 | |
| Amanda Rand | Corporate Director | Jan 1, 2023 |
Owners & managing parties with NPI records 5
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Obstetrics & Gynecology Physician
- Biddeford, ME
- NPI 1902977077
Corporate Director
-
- Interventional Cardiology Physician
- Scarborough, ME
- NPI 1326019563
Corporate Director
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- General Acute Care Hospital
- Portland, ME
- NPI 1376847343
Practitioners & affiliated clinicians
Affiliated clinicians 2,518
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287100800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1671408000000",
"number": "1710297494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 BRAMHALL ST",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041023134",
"telephone_number": "207-662-6562"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 BRICKHILL AVE",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "04106",
"telephone_number": "207-773-1728",
"fax_number": "207-772-4062"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MAINEHEALTH",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MAINE MEDICAL CENTER",
"enumeration_date": "2010-10-15",
"last_updated": "2022-12-19",
"certification_date": "2022-12-19",
"status": "A",
"authorized_official_last_name": "INZANA",
"authorized_official_first_name": "LUGENE",
"authorized_official_middle_name": "ANTHONY",
"authorized_official_title_or_position": "ASSOCIATE CFO",
"authorized_official_telephone_number": "207-662-3538"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Urology",
"state": null,
"license": null,
"primary": true
},
{
"code": "282N00000X",
"taxonomy_group": "",
"desc": "General Acute Care Hospital",
"state": "ME",
"license": "37563",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.1068.1",
"affiliationName": "Cobius Healthcare Solutions",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "2720 Dundee Rd",
"city": "Northbrook",
"state": "IL",
"country_code": "US",
"postal_code": "600622609",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "Maine Medical Partners Urology",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Maine Medical Partners Urology",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in South Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.