NPIMap

Organization Active NPI

Ibis Health Services-Maine LLC

  • Internal Medicine Physician
  • Portland, ME
National Provider Identifier
1942798707
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
IBIS HEALTH SERVICES-MAINE LLC
Practice address
40 Saint Lawrence St
Portland, ME 04101-4316
Phone
(207) 558-9800
NPI assigned
Apr 27, 2018
Last updated
Aug 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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

Authorized official

Name
Gary Janko
Title
Authorized User
Phone
(603) 921-4947

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

40 Saint Lawrence St
Portland, ME 04101-4316

Mailing address

215 Ayer Rd Unit 797
Harvard, MA 01451-5033
Phone (978) 635-9090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181210002959 ME Part B Supplier - Clinic/Group Practice 5698019131 Receives reassigned benefits from 11 practitioners
Practice locations: Portland, ME

National Provider Directory

National Provider Directory

Locations

140 Main St
Ste 3
Freeport, ME 04032
Phone (207) 558-9800

44 Elm St
Limerick, ME 04048
Phone (207) 793-9586

136 US Route 1
Ste 7
Scarborough, ME 04074
Phone (207) 558-9800

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1524787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1942798707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 AYER RD UNIT 797",
            "city": "HARVARD",
            "state": "MA",
            "postal_code": "014515033",
            "telephone_number": "978-635-9090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 SAINT LAWRENCE ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041014316",
            "telephone_number": "207-558-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IBIS HEALTH SERVICES-MAINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-27",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A",
        "authorized_official_last_name": "JANKO",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "AUTHORIZED USER",
        "authorized_official_telephone_number": "603-921-4947"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Aug 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.