Individual provider Active NPI

Charles O'Brien, D.O.

  • Diagnostic Radiology Physician
  • York, ME
National Provider Identifier
1801877832
Registry record updated Jul 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
1210 Issued in ME
Practice address
15 Hospital Dr
York, ME 03909-1011
Phone
(207) 363-4321
NPI assigned
Nov 8, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 1210 ME Primary

Addresses

Primary practice location

15 Hospital Dr
York, ME 03909-1011

Mailing address

PO Box 1849
Lewiston, ME 04241-1849
Phone (207) 784-2554

Other identifiers 1

IdentifierTypeStateIssuer
30005141MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050627000667 ME Practitioner - Diagnostic Radiology 0749225050 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1210MEMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
York Hospital CurrentSince Jan 1, 2014 Accepting new patients
Seacoast Pathology Inc Current Accepting new patients
South Coast Radiology, P.a. Diagnostic Radiology Current Accepting new patients

Locations

15 Hospital Dr
York, ME 03909
Phone (207) 351-2478

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": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184544000000",
    "number": "1801877832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1849",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042411849",
            "telephone_number": "207-784-2554",
            "fax_number": "207-777-5363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 HOSPITAL DR",
            "city": "YORK",
            "state": "ME",
            "postal_code": "039091011",
            "telephone_number": "207-363-4321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "CHARLES",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-08",
        "last_updated": "2007-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ME",
            "license": "1210",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30005141",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in York, ME

Sources for this page

Verify at the official NPI Registry.