NPIMap

Individual provider Active NPI

Charles Kevin Bergeron Poulin

  • Family Medicine Physician
  • Lewiston, ME
National Provider Identifier
1992291249
Registry record updated Jul 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
EC18180 Issued in ME
Practice address
76 High St
Lewiston, ME 04240-7649
Phone
(207) 795-2800
NPI assigned
Jul 10, 2018
Last updated
Jul 10, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X EC18180 ME Primary

Addresses

Primary practice location

76 High St
Lewiston, ME 04240-7649

Mailing address

76 High St
Lewiston, ME 04240-7649
Phone (207) 795-2800

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
I20220315001380 ME Practitioner - Family Practice 7719238286 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bridgton HospitalGroup PAC ID 8123919099, 33 clinicians

Practice addresses (Care Compare)

15 Hospital Dr
Bridgton, ME 04009-1156
Phone (207) 647-4234

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.02 of 100Reported as group
Quality
59.99
Promoting interoperability
99
Improvement activities
40
Cost
74.25

Merit-based Incentive Payment System (MIPS)

Final score
97.93 of 100Reported as apm
Quality
83.31
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
84.57 of 100Reported as group
Quality
66.56
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
EC18180MEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Maine Medical Center CurrentSince Sep 3, 2022 Accepting new patients
Bridgton Hospital CurrentSince Dec 3, 2021 Accepting new patients
Rumford Hospital CurrentSince Sep 1, 2022 Accepting new patients
Bridgton Hospital CurrentSince Dec 3, 2021 Accepting new patients
Central Maine Medical Center CurrentSince Sep 3, 2022 Accepting new patients
Rumford Hospital CurrentSince Sep 1, 2022 Accepting new patients
Central Maine Medical Center Past Accepting new patients

Locations

10 Hospital Dr
Bridgton, ME 04009
Phone (207) 647-6000

15 Hospital Dr
Bridgton, ME 04009
Phone (207) 647-3421

300 Main St
Lewiston, ME 04240
Phone (207) 795-2400

76 High St
Lewiston, ME 04240
Phone (207) 795-2800

410 Roosevelt Trl
Naples, ME 04055
Phone (207) 693-6106

420 Franklin St
Rumford, ME 04276
Phone (207) 364-4581

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/4517c430-03bf-4e32-b324-1387cc4e73f3/

Organizations & group practices 7

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 5

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": "1531180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531180800000",
    "number": "1992291249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "76 HIGH ST",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042407649",
            "telephone_number": "207-795-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76 HIGH ST",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042407649",
            "telephone_number": "207-795-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGERON POULIN",
        "first_name": "CHARLES KEVIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-10",
        "last_updated": "2018-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "EC18180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, ME

Sources for this page

Verify at the official NPI Registry.