Charles Kevin Bergeron Poulin
Individual provider Active NPI Family Medicine Physician · Lewiston, ME
NPI 1992291249 · NPPES record last updated Jul 10, 2018
Key facts
- NPI
- 1992291249
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- EC18180 (ME)
- Practice address
- 76 High St
Lewiston, ME 04240-7649 - Phone
- (207) 795-2800
- NPI assigned
- Jul 10, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Bridgton Hospital
Practice addresses (Care Compare)
15 Hospital Dr
Bridgton, ME 04009-1156
Phone (207) 647-4234
Hospital & facility affiliations
- Andwell Health Partners
- Andwell Health Partners
- Bridgton Hospital
- Central Maine Medical Center
- Mainehealth Stephens Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 85.02 of 100
- Quality
- 59.99
- Promoting interoperability
- 99
- Improvement activities
- 40
- Cost
- 74.25
Merit-based Incentive Payment System (MIPS)
- Final score
- 97.93 of 100
- Quality
- 83.31
- Promoting interoperability
- 100
- Improvement activities
- 40
Merit-based Incentive Payment System (MIPS)
- Final score
- 84.57 of 100
- Quality
- 66.56
- Promoting interoperability
- 99
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220315001380 | ME | Practitioner - Family Practice | 7719238286 | Reassigns benefits to 5 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| EC18180 | ME | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Maine Medical Center | Current |
Accepting new patients | |
| Rumford Hospital | Current |
Accepting new patients | |
| Bridgton Hospital | Current |
Accepting new patients | |
| Central Maine Medical Center | Current |
Accepting new patients | |
| Bridgton Hospital | Current |
Accepting new patients | |
| Rumford Hospital | Current |
Accepting new patients | |
| Central Maine Medical Center | Past | Accepting new patients |
Locations
15 Hospital Dr
Bridgton, ME 04009
Phone (207) 647-3421
10 Hospital Dr
Bridgton, ME 04009
Phone (207) 647-6000
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
- https://fhir-myrecord.cerner.com/r4/4517c430-03bf-4e32-b324-1387cc4e73f3/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | EC18180 | ME | Yes |
Addresses
Primary practice location
76 High St
Lewiston, ME 04240-7649
Mailing address
76 High St
Lewiston, ME 04240-7649
Phone (207) 795-2800
Other providers in Lewiston, ME
- Steven L Bender
- Joshua Michael Benner
- John J Bennett
- Justin B Bennett
- Kate Benson
- Claire E. Bergeron
- Roger L. Bergeron
- Julia Frances Bergquist
- Robert W Berks
- Michael Scott Berlowitz
All providers in Lewiston, ME · Family Medicine Physician in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.