Organization Active NPI

Coram Alternate Site Services, Inc.

Doing business as Coram CVS/specialty Infusion Services

  • Home Infusion Agency
  • Portland, ME
National Provider Identifier
1932477809
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion AgencyTaxonomy code 251F00000X
Legal business name
CORAM ALTERNATE SITE SERVICES, INC.
Doing business as
Coram CVS/specialty Infusion Services
Practice address
191 Marginal Way
Portland, ME 04101-3387
Phone
(508) 989-9373
NPI assigned
Dec 7, 2011
Organization subpart
Yes
Parent organization
CORAM ALTERNATE SITE SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Tricia Lacavich
Title
President
Phone
(314) 306-3255

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X
Home Infusion Agency 251F00000X Primary

Addresses

Primary practice location

191 Marginal Way
Portland, ME 04101-3387

Mailing address

PO Box 809160
Chicago, IL 60680-9160
Phone (303) 672-8631

Other identifiers 2

IdentifierTypeStateIssuer
2008717OtherNCPDP
PH50001464OtherMEPHARMACY PERMIT

Other names 1

  • Coram CVS/specialty Infusion Services Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

National Provider Directory

National Provider Directory
Part of
Coram Healthcare

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

12 Northbrook Dr
Bldg B
Falmouth, ME 04105
Phone (207) 781-0028

12 Northbrook Dr
Ste 1
Falmouth, ME 04105
Phone (207) 781-0028

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1323216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1932477809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 809160",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606809160",
            "telephone_number": "303-672-8631",
            "fax_number": "303-298-0047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 MARGINAL WAY",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041013387",
            "telephone_number": "508-989-9373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORAM ALTERNATE SITE SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CORAM ALTERNATE SITE SERVICES, INC.",
        "enumeration_date": "2011-12-07",
        "last_updated": "2023-03-07",
        "certification_date": "2022-12-16",
        "status": "A",
        "authorized_official_last_name": "LACAVICH",
        "authorized_official_first_name": "TRICIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-306-3255"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2008717",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY PERMIT",
            "identifier": "PH50001464",
            "state": "ME"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Coram CVS/specialty Infusion Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coram CVS/specialty Infusion Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 7, 2023; 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.