Active NPI
Meredith Beauregard, PA
- Physician Assistant
- Portland, ME
National Provider Identifier
1013967918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA883
- Practice address
- 22 Bramhall St
Pavilion 1203
Portland, ME 04102 - Phone
- (207) 662-4618
- Fax
- (207) 662-6254
- NPI assigned
- May 11, 2006
- Sex
- Female
- 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 | PA883 | ME | Primary |
Addresses
Primary practice location
22 Bramhall St
Pavilion 1203
Portland, ME 04102
Mailing address
301 US Route 1
Building C
Scarborough, ME 04074-7609
Phone (207) 396-8600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 432498699 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060519000078 | ME | Practitioner - Physician Assistant | 7214948645 | Reassigns benefits to 2 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mainehealth
Practice addresses (Care Compare)
22 Bramhall St
Portland, ME 04102-3134
Phone (207) 885-9905
Hospital & facility affiliations
- Mainehealth Maine Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 97.93 of 100
- Quality
- 83.31
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA883 | ME | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mainehealth | Current | Accepting new patients | |
| Maine Medical Partners | Current | Accepting new patients | |
| Maine Medical Partners | Current | Accepting new patients | |
| Mainehealth | Current | Accepting new patients | |
| Intermed, PA | Past | Accepting new patients | |
| Intermed, PA | Past | Accepting new patients |
Locations
22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179
22 Bramhall St
#1203
Portland, ME 04102
Phone (207) 662-4618
100 Campus Dr
Unit 107
Scarborough, ME 04074
Phone (207) 396-7565
584 Roosevelt Trl
Windham, ME 04062
Phone (207) 892-3216
Interoperability endpoints
- mbeauregard9591@direct.mmc.mainehealth.org
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 and National Provider Directory roles.
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Hospital & facility affiliations 36
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": "1147305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294012800000",
"number": "1013967918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 US ROUTE 1",
"address_2": "BUILDING C",
"city": "SCARBOROUGH",
"state": "ME",
"postal_code": "040747609",
"telephone_number": "207-396-8600",
"fax_number": "207-396-8632"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 BRAMHALL ST",
"address_2": "PAVILION 1203",
"city": "PORTLAND",
"state": "ME",
"postal_code": "04102",
"telephone_number": "207-662-4618",
"fax_number": "207-662-6254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEAUREGARD",
"first_name": "MEREDITH",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-11",
"last_updated": "2011-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ME",
"license": "PA883",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "432498699",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2011; 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.