NPIMap

Individual provider Active NPI

Timothy Lee Wakeland, MSPT

  • Specialist
  • Ellsworth, ME
National Provider Identifier
1083633002
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
PT1167 Issued in ME
Practice address
37 Commerce Park
Ellsworth, ME 04605-3383
Phone
(207) 667-2422
Fax
(207) 667-0135
NPI assigned
Jul 19, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X PT1167 ME Primary

Addresses

Primary practice location

37 Commerce Park
Ellsworth, ME 04605-3383

Mailing address

37 Commerce Park
Ellsworth, ME 04605-3383
Phone (207) 667-2422

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopaedic Associates of Bangor, PA Specialist Past Accepting new patients
Sunbury Primary Care, P.a. Past Accepting new patients

Organizations & group practices 2

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": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083633002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 COMMERCE PARK",
            "city": "ELLSWORTH",
            "state": "ME",
            "postal_code": "046053383",
            "telephone_number": "207-667-2422",
            "fax_number": "207-667-0135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 COMMERCE PARK",
            "city": "ELLSWORTH",
            "state": "ME",
            "postal_code": "046053383",
            "telephone_number": "207-667-2422",
            "fax_number": "207-667-0135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAKELAND",
        "first_name": "TIMOTHY",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "MSPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "ME",
            "license": "PT1167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellsworth, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.