Bates Mill Dermatology, P.L.L.C.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

016653 Issued in ME

Legal business name

BATES MILL DERMATOLOGY, P.L.L.C.

Practice address

70 Lincoln St
Mill 6
Lewiston, ME 04240-7721

Phone

(207) 795-7540

Fax

(207) 795-7528

NPI assigned

Jul 14, 2006

Last updated

Dec 13, 2021By 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

Maryann G Leonard

Title

Practice Manager

Phone

(207) 795-7540

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ME

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 6

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.

• Peter H Bouman, MD

  • Dermatology Physician
  • Lewiston, ME
  • NPI 1538120043
  Medicare reassignment Care Compare group NPD
• Carrine A. Burns, M.D.

  • MOHS-Micrographic Surgery Physician
  • Lewiston, ME
  • NPI 1063451896

  Dermatology

  Medicare reassignment Care Compare group NPD
• Matthew P Bureau, PA-C

  • Physician Assistant
  • Lewiston, ME
  • NPI 1225037211
  Medicare reassignment Care Compare group
• Alison June Ravis, PHYSICIAN ASSSISTANT

  • Physician Assistant
  • Lewiston, ME
  • NPI 1669449286
  Medicare reassignment Care Compare group
• Laura Sampson Westphal, PA-C

  • Physician Assistant
  • Burlington, VT
  • NPI 1396030953

  ME

  Medicare reassignment Care Compare group
• Marcia A Matuska, MD

  • Dermatology Physician
  • Lewiston, ME
  • NPI 1720147267
  NPD (past)

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639353600000",
    "number": "1972529865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 LINCOLN ST",
            "address_2": "MILL 6",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042407721",
            "telephone_number": "207-795-7540",
            "fax_number": "207-795-7528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 LINCOLN ST",
            "address_2": "MILL 6",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042407721",
            "telephone_number": "207-795-7540",
            "fax_number": "207-795-7528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BATES MILL DERMATOLOGY, P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-13",
        "status": "A",
        "authorized_official_last_name": "LEONARD",
        "authorized_official_first_name": "MARYANN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "207-795-7540"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "ME",
            "license": "016653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Lewiston",
            "affiliation": "N",
            "endpointDescription": "Office",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Lewiston",
            "address_1": "70 Lincoln St",
            "address_2": "Mill 6",
            "city": "Lewiston",
            "state": "ME",
            "country_code": "US",
            "postal_code": "042407721",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jason Barschdorf, PA-C
• Elizabeth Barton
• Carl Eben Barus, M.D.
• Jessica Megan Basaldua, LMSW-CC
• Bates College Health Center
• Brooke L Beal, RD
• Pauline V. Beale, O.D.
• Lexi Jade Beals, CADC, LSW
• Randy Beard
• Kara Lee Beaule, LCPC-C

• Dermatology Physician in Lewiston, ME
• Providers in Lewiston, ME by specialty
• Dermatology Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.