NPIMap

Individual provider Active NPI

Corey-Michael Wilcox, FNP

  • Family Nurse Practitioner
  • South Portland, ME
National Provider Identifier
1730072711
Registry record updated Dec 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
CNP251322 Issued in ME
Practice address
100 Foden Rd Ste 203
South Portland, ME 04106-2327
Phone
(207) 874-1489
NPI assigned
May 30, 2025
Last updated
Dec 17, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X CNP251322 ME
Family Nurse Practitioner 363LF0000X CNP251322 ME Primary

Addresses

Primary practice location

100 Foden Rd Ste 203
South Portland, ME 04106-2327

Mailing address

100 Gannett Dr Ste C
South Portland, ME 04106-5900
Phone (207) 347-2947

Other practice location 1

96 Campus Dr
Scarborough, ME 04074-7163
Phone (207) 885-9905

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
I20250815003913 ME Practitioner - Nurse Practitioner 0244739381 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
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

96 Campus Dr
Scarborough, ME 04074-7163
Phone (207) 885-9905

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CNP251322MEMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Mar 2, 2026 Accepting new patients
Intermed, PA CurrentSince Jun 16, 2025 Accepting new patients
Intermed, PA CurrentSince Jun 16, 2025 Accepting new patients
Mainehealth CurrentSince Mar 2, 2026 Accepting new patients

Locations

96 Campus Dr
Scarborough, ME 04074
Phone (207) 885-9905

100 Foden Rd
South Portland, ME 04106
Phone (207) 828-1122

100 Foden Rd
Ste 203
South Portland, ME 04106
Phone (207) 828-0361

100 Foden Rd
Ste W-100
South Portland, ME 04106
Phone (207) 523-3900

100 Gannett Dr
Ste C
South Portland, ME 04106
Phone (207) 523-3649

Organizations & group practices 5

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": "1748563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765929600000",
    "number": "1730072711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 GANNETT DR STE C",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041065900",
            "telephone_number": "207-347-2947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 FODEN RD STE 203",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041062327",
            "telephone_number": "207-874-1489"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "96 Campus Dr",
            "address_purpose": "LOCATION",
            "city": "Scarborough",
            "state": "ME",
            "postal_code": "040747163",
            "country_code": "US",
            "telephone_number": "207-885-9905",
            "fax_number": "207-396-5600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILCOX",
        "first_name": "COREY-MICHAEL",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-05-30",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "ME",
            "license": "CNP251322",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ME",
            "license": "CNP251322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Portland, ME

Sources for this page

Verify at the official NPI Registry.