Active NPI
Holly Haeberlein
- Dermatology Physician
- Bangor, ME
National Provider Identifier
1932537800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- CNP131096
- Practice address
- 90 Ridgewood Dr
Bangor, ME 04401-2652 - Phone
- (207) 942-0669
- Fax
- (207) 947-3143
- NPI assigned
- Oct 31, 2013
- 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 |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | CNP131096 | ME | Primary |
Addresses
Primary practice location
90 Ridgewood Dr
Bangor, ME 04401-2652
Mailing address
23 Brentwood Ave
Bangor, ME 04401-4201
Phone (207) 942-0669
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
381 Main St
Orono, ME 04473-3446
Phone (207) 942-0669
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.22 of 100
- Quality
- 85.35
- Improvement activities
- 40
- Cost
- 86.93
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Penobscot Valley Dermatology, P.a. | Current | Accepting new patients |
Locations
90 Ridgewood Dr
Bangor, ME 04401
Phone (207) 262-3744
381 Main St
Orono, ME 04473
Phone (207) 942-0669
Organizations & group practices 1
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.
-
- Specialist
- Bangor, ME
- NPI 1952536880
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1383177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383177600000",
"number": "1932537800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23 BRENTWOOD AVE",
"city": "BANGOR",
"state": "ME",
"postal_code": "044014201",
"telephone_number": "207-942-0669",
"fax_number": "207-947-3143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 RIDGEWOOD DR",
"city": "BANGOR",
"state": "ME",
"postal_code": "044012652",
"telephone_number": "207-942-0669",
"fax_number": "207-947-3143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAEBERLEIN",
"first_name": "HOLLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-10-31",
"last_updated": "2013-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "ME",
"license": "CNP131096",
"primary": true
}
],
"identifiers": [],
"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 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.