Individual provider Active NPI

Cynthia L Nulton, AUD

  • Audiologist
  • Bangor, ME
National Provider Identifier
1790712396
Registry record updated Oct 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
AP3991 Issued in ME
Practice address
6 Telcom Dr
Bangor, ME 04401-3072
Phone
(207) 941-2850
NPI assigned
Jun 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X A469 NH
Audiologist 231H00000X AP3991 ME Primary

Addresses

Primary practice location

6 Telcom Dr
Bangor, ME 04401-3072

Mailing address

PO Box 1599
Bangor, ME 04402-1599

Other practice location 1

1 Medical Center Dr
Lebanon, NH 03756-1000
Phone (603) 650-8123

Other identifiers 2

IdentifierTypeStateIssuer
30432224MedicaidNH
1009205MedicaidVT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230824004012 ME Practitioner - Qualified Audiologist 4082888219 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Penobscot Community Health CenterGroup PAC ID 0143212670, 135 clinicians

Practice addresses (Care Compare)

6 Telcom Dr
Bangor, ME 04401-3072
Phone (207) 941-2850

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AP3991MEMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Penobscot Community Health Center CurrentSince Sep 1, 2023 Accepting new patients
Penobscot Community Health Center CurrentSince Sep 1, 2023 Accepting new patients
Penobscot Community Health Center Past Accepting new patients

Locations

6 Telcom Dr
Bangor, ME 04401
Phone (207) 941-2850

1012 Union St
Ste 1
Bangor, ME 04401
Phone 2079455247407

1012 Union St
Ste 3
Bangor, ME 04401
Phone (207) 404-8040

6 Telcom Dr
Fl 1
Bangor, ME 04401
Phone (207) 941-2850

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.

NPI Registry JSON

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696291200000",
    "number": "1790712396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1599",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 TELCOM DR",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013072",
            "telephone_number": "207-941-2850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "NH",
            "postal_code": "037561000",
            "country_code": "US",
            "telephone_number": "603-650-8123",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NULTON",
        "first_name": "CYNTHIA",
        "middle_name": "L",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-27",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NH",
            "license": "A469",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "ME",
            "license": "AP3991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30432224",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1009205",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.