NPIMap

Individual provider Active NPI

Alexandra Maria Elizabeth Idenburg, MD, MRCGP(UK)

  • General Practice Physician
  • Pittsfield, ME
National Provider Identifier
1992133102
Registry record updated Nov 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
MD19326 Issued in ME
Practice address
105 Main St
Pittsfield, ME 04967-4364
Phone
(207) 487-7292
Fax
(207) 487-7156
NPI assigned
Oct 25, 2013
Last updated
Nov 27, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X MD19326 ME Primary

Addresses

Primary practice location

105 Main St
Pittsfield, ME 04967-4364

Mailing address

105 Main St
Pittsfield, ME 04967-4364
Phone (207) 487-7292

Other practice location 1

242 Brunswick St
Old Town, ME 04468-1613
Phone (207) 827-6128

Other practice location 2

447 N Main St
Pittsfield, ME 04967-3707
Phone (207) 487-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140722000965 ME Practitioner - Family Practice 5890911150 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Penobscot Community Health CenterGroup PAC ID 0143212670, shared by 14 NPIs, 135 clinicians

Practice addresses (Care Compare)

Detroit, ME 04929
Phone (207) 404-3873

1012 Union St
Bangor, ME 04401-3058

242 Brunswick St
Old Town, ME 04468-1613
Phone (207) 827-6128

992 Union St
Bangor, ME 04401-3057

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
92.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD19326MEMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Penobscot Community Health Center CurrentSince Dec 13, 2024 Accepting new patients
Calais Community Hospital CurrentSince Sep 1, 2018 Accepting new patients
Calais Community Hospital CurrentSince Sep 1, 2018 Accepting new patients
Penobscot Community Health Center General Practice Current Accepting new patients
Pittsfield Medical Center CurrentSince Apr 15, 2018 Accepting new patients
Penobscot Community Health Center CurrentSince Dec 13, 2024 Accepting new patients
Katahdin Health Care LLC Past Accepting new patients
Dover-Foxcroft Healthcare, LLC Past Accepting new patients
Penobscot Community Health Center Past Accepting new patients
Dexter Manor Associates Past Accepting new patients
Woodlawn Nursing Home Inc Past Accepting new patients

Locations

1012 Union St
Ste 1
Bangor, ME 04401
Phone 2079455247407

1012 Union St
Ste 3
Bangor, ME 04401
Phone (207) 404-8040

37 Palmer St
Calais, ME 04619
Phone (207) 454-3307

242 Brunswick St
Old Town, ME 04468
Phone (207) 827-6128

105 Main St
Pittsfield, ME 04967
Phone (207) 404-3873

Interoperability endpoints

  • Direct secure messaging: alexandra.idenburg.1@19451.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/19451/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir-usa.unify.chbase.com/org/calais-879327e9

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Katahdin Health Care LLCMillinocket, ME, CCN 205149 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Nov 1, 2021
Nov 1, 2021

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1382659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732665600000",
    "number": "1992133102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 MAIN ST",
            "city": "PITTSFIELD",
            "state": "ME",
            "postal_code": "049674364",
            "telephone_number": "207-487-7292",
            "fax_number": "207-487-7156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 MAIN ST",
            "city": "PITTSFIELD",
            "state": "ME",
            "postal_code": "049674364",
            "telephone_number": "207-487-7292",
            "fax_number": "207-487-7156"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "242 Brunswick St",
            "address_purpose": "LOCATION",
            "city": "Old Town",
            "state": "ME",
            "postal_code": "044681613",
            "country_code": "US",
            "telephone_number": "207-827-6128",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "447 N Main St",
            "address_purpose": "LOCATION",
            "city": "Pittsfield",
            "state": "ME",
            "postal_code": "049673707",
            "country_code": "US",
            "telephone_number": "207-487-4000",
            "fax_number": "207-487-3790",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IDENBURG",
        "first_name": "ALEXANDRA",
        "middle_name": "MARIA ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "MD, MRCGP(UK)",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-10-25",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "ME",
            "license": "MD19326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pittsfield, ME

Sources for this page

Verify at the official NPI Registry.