Sebago Medical Group Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

SEBAGO MEDICAL GROUP INC

Practice address

110 Tandberg TRL Ste G
Windham, ME 04062-5206

Phone

(207) 595-8756

NPI assigned

May 4, 2022

Last updated

May 4, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Stephanie Elena Chin, DNP, FNP-BC, APRN-CNNPI 1447303961

Title

Chief Executive Officer

Phone

(207) 595-8756

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stephanie Elena Chin, FNP-BC, APRN-CNP

  • Family Nurse Practitioner
  • Portland, ME
  • NPI 1447303961
  NPD Authorized official
• Christina Marie Wales, REGISTERED NURSE

  • Licensed Practical Nurse
  • Windham, ME
  • NPI 1003788159
  NPD

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

{
    "created_epoch": "1651622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651622400000",
    "number": "1811632680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 PUNKIN VALLEY DR",
            "city": "BRIDGTON",
            "state": "ME",
            "postal_code": "040093425",
            "telephone_number": "207-595-8756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 TANDBERG TRL STE G",
            "city": "WINDHAM",
            "state": "ME",
            "postal_code": "040625206",
            "telephone_number": "207-595-8756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEBAGO MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-04",
        "last_updated": "2022-05-04",
        "certification_date": "2022-05-04",
        "status": "A",
        "authorized_official_last_name": "CHIN",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "ELENA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "207-595-8756",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP, FNP-BC, APRN-CN"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Windham, ME
• Providers in Windham, ME by specialty
• Clinic/Center in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.