Individual provider Active NPI

Wil Daniel Palmer, PA-C

  • Physician Assistant
  • Portland, ME
National Provider Identifier
1053020172
Registry record updated Mar 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2804 Issued in ME
Practice address
818 Congress St
Portland, ME 04102-3112
Phone
(207) 773-8161
Fax
(207) 773-1489
NPI assigned
Nov 17, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2025

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 PA2804 ME Primary

Addresses

Primary practice location

818 Congress St
Portland, ME 04102-3112

Mailing address

818 Congress St
Portland, ME 04102-3112
Phone (207) 773-8161

Other practice location 1

4900 Mueller Blvd
Austin, TX 78723-3051
Phone (512) 324-0000

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250521002432 ME Practitioner - Physician Assistant 0941729107 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Mar 31, 2025 Accepting new patients
Mainehealth CurrentSince Mar 31, 2025 Accepting new patients
Mainehealth Past Accepting new patients

Locations

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

818 Congress St
Portland, ME 04102
Phone (207) 773-8161

Interoperability endpoints

  • Direct secure messaging: wpalmer900485@direct.mmc.mainehealth.org

Organizations & group practices 4

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1668643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742256000000",
    "number": "1053020172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "818 CONGRESS ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023112",
            "telephone_number": "207-773-8161",
            "fax_number": "207-773-1489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 CONGRESS ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023112",
            "telephone_number": "207-773-8161",
            "fax_number": "207-773-1489"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4900 Mueller Blvd",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787233051",
            "country_code": "US",
            "telephone_number": "512-324-0000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PALMER",
        "first_name": "WIL",
        "middle_name": "DANIEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-11-17",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA2804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.