Active NPI
Jake Pristupa
- Physician Assistant
- Bangor, ME
National Provider Identifier
1013856608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 55 Broadway Ste 2
Bangor, ME 04401-5201 - Phone
- (207) 947-0496
- NPI assigned
- Mar 27, 2026
- Last updated
- Mar 27, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
55 Broadway Ste 2
Bangor, ME 04401-5201
Mailing address
515 S Center St Apt 4
Grove City, PA 16127-1305
Phone (770) 905-9791
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2026
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
43 Whiting Hill Rd
Suite 250
Brewer, ME 04412-1018
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1774569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774569600000",
"number": "1013856608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "515 S CENTER ST APT 4",
"city": "GROVE CITY",
"state": "PA",
"postal_code": "161271305",
"telephone_number": "770-905-9791",
"fax_number": "770-905-9791"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 BROADWAY STE 2",
"city": "BANGOR",
"state": "ME",
"postal_code": "044015201",
"telephone_number": "207-947-0496"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRISTUPA",
"first_name": "JAKE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-03-27",
"last_updated": "2026-03-27",
"certification_date": "2026-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.