Active NPI
Elizabeth K Ackerson, MD
- Internal Medicine Physician
- Portland, ME
National Provider Identifier
1912920117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 012073
- Practice address
- 1685 Congress Street
Portland, ME 04102 - Phone
- (207) 774-5816
- Fax
- (207) 774-3329
- NPI assigned
- Jul 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 012073 | ME | Primary |
Addresses
Primary practice location
1685 Congress Street
Portland, ME 04102
Mailing address
100 Foden Road East
Suite 201
South Portland, ME 04106
Phone (207) 828-0361
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010559 | Other | ANTHEM | |
| 1040729 | Other | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012073 | ME | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1912920117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 FODEN ROAD EAST",
"address_2": "SUITE 201",
"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": "1685 CONGRESS STREET",
"city": "PORTLAND",
"state": "ME",
"postal_code": "04102",
"telephone_number": "207-774-5816",
"fax_number": "207-774-3329"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ACKERSON",
"first_name": "ELIZABETH",
"middle_name": "K",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "ME",
"license": "012073",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "010559",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "1040729",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.