Individual provider Active NPI

William C Ervin, MD

  • Internal Medicine Physician
  • Portland, ME
National Provider Identifier
1730148859
Registry record updated Nov 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
009853 Issued in ME
Practice address
84 Marginal Way
Suite 700
Portland, ME 04101-2443
Phone
(207) 774-5816
Fax
(207) 523-8597
NPI assigned
Mar 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 009853 ME Primary

Addresses

Primary practice location

84 Marginal Way
Suite 700
Portland, ME 04101-2443

Mailing address

100 Foden Road West
Suite 203
South Portland, ME 04106
Phone (207) 828-0361

Other identifiers 3

IdentifierTypeStateIssuer
238590099MedicaidME
1044610OtherAETNA
010556OtherANTHEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240613000186 ME Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 8022185297

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
009853MEMDInternal Medicine Physician

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Gentiva IPortland, ME, CCN 201525 Hospice Contracted Managing Employee Jul 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1142640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289952000000",
    "number": "1730148859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 FODEN ROAD WEST",
            "address_2": "SUITE 203",
            "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": "84 MARGINAL WAY",
            "address_2": "SUITE 700",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041012443",
            "telephone_number": "207-774-5816",
            "fax_number": "207-523-8597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERVIN",
        "first_name": "WILLIAM",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-18",
        "last_updated": "2010-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ME",
            "license": "009853",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "238590099",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "1044610",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "010556",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.