| Bishop Medical Group Llc | |
|
1250 Forest Ave Ste 201 Portland ME 04103-6403 | |
| (207) 671-3047 | |
| Not Available |
| Full Name | Bishop Medical Group Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1250 Forest Ave Ste 201, Portland, Maine |
| Authorized Official Name and Position | John Buro (MANAGER) |
| Authorized Official Contact | 2079106580 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bishop Medical Group Llc 1250 Forest Ave Ste 201 Portland ME 04103-6403 Ph: () - | Bishop Medical Group Llc 1250 Forest Ave Ste 201 Portland ME 04103-6403 Ph: (207) 671-3047 |
| NPI Number | 1487256186 |
|---|---|
| Provider Enumeration Date | 11/09/2020 |
| Last Update Date | 06/03/2024 |
| Certification Date | 06/03/2024 |
| Medicare PECOS PAC ID | 6800298654 |
|---|---|
| Medicare Enrollment ID | O20210715002780 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487256186 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | (* (Not Available)) | Primary |
| Provider Name | Benjamin Crocker |
|---|---|
| Provider Type | Practitioner - Neuropsychiatry |
| Provider Identifiers | NPI Number: 1841297009 PECOS PAC ID: 2466427604 Enrollment ID: I20040831000787 |
| Provider Name | Timothy Dewitt Carnes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215917885 PECOS PAC ID: 7618944505 Enrollment ID: I20040910000952 |
| Provider Name | Randi-anne Bruneau |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609184654 PECOS PAC ID: 1052509916 Enrollment ID: I20101220001027 |
| Provider Name | Jonathan C Fellers |
|---|---|
| Provider Type | Practitioner - Neuropsychiatry |
| Provider Identifiers | NPI Number: 1508091281 PECOS PAC ID: 6608021332 Enrollment ID: I20150831000427 |
| Provider Name | Amanda E Sedgewick |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1588076715 PECOS PAC ID: 8123244050 Enrollment ID: I20180821003515 |
| Provider Name | Alison M Tetrault |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851935878 PECOS PAC ID: 3870907256 Enrollment ID: I20210126001616 |
| Provider Name | Gabrielle Bowker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619538782 PECOS PAC ID: 9638571342 Enrollment ID: I20210716000931 |
| Provider Name | Julie D Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588341788 PECOS PAC ID: 7517315310 Enrollment ID: I20231204001960 |
| Provider Name | Melissa C. White |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982019550 PECOS PAC ID: 0941652820 Enrollment ID: I20240116003183 |
| Provider Name | Allison Leslie Hart |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376190173 PECOS PAC ID: 1557803632 Enrollment ID: I20240604003056 |
| Provider Name | Robert Taylor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871221101 PECOS PAC ID: 5890234827 Enrollment ID: I20240822001092 |
| Provider Name | Sarah Malka Mcvicar |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1780282541 PECOS PAC ID: 9234679523 Enrollment ID: I20240913000214 |
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