NPIMap

Individual provider Active NPI

John Mladucky, PA-C

  • Physician Assistant
  • South Portland, ME
National Provider Identifier
1033777362
Registry record updated Sep 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA1957 Issued in ME
Practice address
265 Western Ave Ste 2
South Portland, ME 04106-2458
Phone
(207) 661-0200
Fax
(207) 661-0299
NPI assigned
Jun 1, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA1957 ME Primary

Addresses

Primary practice location

265 Western Ave Ste 2
South Portland, ME 04106-2458

Mailing address

265 Western Ave Ste 2
South Portland, ME 04106-2458
Phone (207) 661-0200

Other practice location 1

175 Fore River Pkwy
Portland, ME 04102-2779
Phone (207) 879-3000

Other practice location 2

655 Main St
Saco, ME 04072-1699
Phone (207) 294-5600

Other practice location 3

300 Main St
Lewiston, ME 04240-7027
Phone (207) 795-0111

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
I20190827002535 ME Practitioner - Physician Assistant 6709114846 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Maine Medical CenterGroup PAC ID 2567379563, 344 clinicians
Mercy HospitalGroup PAC ID 6103737812, 307 clinicians

Practice addresses (Care Compare)

12 High St
Suite 200
Lewiston, ME 04240-7689
Phone (207) 795-5770

155 Rover River Pkwy
Portland, ME 04102-2779
Phone (207) 879-3000

175 Fore River Pkwy
Portland, ME 04102-2779
Phone (207) 879-3000

300 Main St
Lewiston, ME 04240-7027
Phone (207) 753-3900

40 Park Rd
Westbrook, ME 04092-3188
Phone (207) 857-8174

77 Bates St
Suite 201
Lewiston, ME 04240-7637
Phone (207) 795-5784

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
81.67 of 100Reported as group
Quality
60.7
Promoting interoperability
91
Improvement activities
40
Cost
73.8

Merit-based Incentive Payment System (MIPS)

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA1957MEMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Oct 4, 2021 Accepting new patients
Rumford Hospital CurrentSince Dec 11, 2023 Accepting new patients
Central Maine Medical Center CurrentSince Dec 11, 2023 Accepting new patients
Mercy Hospital CurrentSince Aug 4, 2019 Accepting new patients
Bridgton Hospital CurrentSince Dec 11, 2023 Accepting new patients
Central Maine Medical Center CurrentSince Dec 11, 2023 Accepting new patients
Mainehealth CurrentSince Oct 4, 2021 Accepting new patients
Mercy Hospital Past Accepting new patients
Central Maine Medical Center Past Accepting new patients

Locations

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

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

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

175 Fore River Pkwy
Portland, ME 04102
Phone (207) 553-6105

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

655 Main St
Saco, ME 04072
Phone (207) 283-1407

25A June St
Ste 11
Sanford, ME 04073
Phone (207) 282-3666

105 Topsham Fair Mall Rd
Unit 2
Topsham, ME 04086
Phone (207) 798-6300

40 Park Rd
Westbrook, ME 04092
Phone (207) 857-8174

Interoperability endpoints

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

Organizations & group practices 12

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.

Hospital & facility affiliations 4

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": "1559347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790121600000",
    "number": "1033777362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "265 WESTERN AVE STE 2",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041062458",
            "telephone_number": "207-661-0200",
            "fax_number": "207-661-0299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "265 WESTERN AVE STE 2",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041062458",
            "telephone_number": "207-661-0200",
            "fax_number": "207-661-0299"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "175 Fore River Pkwy",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "ME",
            "postal_code": "041022779",
            "country_code": "US",
            "telephone_number": "207-879-3000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "655 Main St",
            "address_purpose": "LOCATION",
            "city": "Saco",
            "state": "ME",
            "postal_code": "040721699",
            "country_code": "US",
            "telephone_number": "207-294-5600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Main St",
            "address_purpose": "LOCATION",
            "city": "Lewiston",
            "state": "ME",
            "postal_code": "042407027",
            "country_code": "US",
            "telephone_number": "207-795-0111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MLADUCKY",
        "first_name": "JOHN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-01",
        "last_updated": "2026-09-23",
        "certification_date": "2026-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA1957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Portland, ME

Sources for this page

Verify at the official NPI Registry.