Individual provider Active NPI

Paul Anthony Fallon, M.D

  • Psychiatry Physician
  • Portsmouth, NH
National Provider Identifier
1093889206
Registry record updated Jul 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
5612N Issued in NH
Practice address
1145 Sagamore Ave
Portsmouth, NH 03801-5585
Phone
(603) 431-6703
Fax
(603) 430-3753
NPI assigned
Nov 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 5612N NH Primary

Addresses

Primary practice location

1145 Sagamore Ave
Portsmouth, NH 03801-5585

Mailing address

1145 Sagamore Ave
Portsmouth, NH 03801-5585
Phone (603) 431-6703

Other identifiers 2

IdentifierTypeStateIssuer
7706655Y0NH01OtherNHBHN
99003227MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH, MA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20081217000122 NH Practitioner - Psychiatry 5890857361 Reassigns benefits to 1 organization
I20101215000568 MA Practitioner - Psychiatry 5890857361 Reassigns benefits to 1 organization
Practice locations: Georgetown, MA

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Harvard Medical School, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Seacoast Mental Health Center IncGroup PAC ID 0749240208, 45 clinicians

Practice addresses (Care Compare)

1145 Sagamore Ave
Portsmouth, NH 03801-5503
Phone (603) 431-6703

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
5612NHMDMental Health Counselor
5612NNHMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Amber Moon Wellness, PLLC Current Accepting new patients
Northeast Behavioral Health Corporation CurrentSince Sep 21, 2010 Accepting new patients
Seacoast Mental Health Center, Inc. CurrentSince Mar 18, 2008 Accepting new patients

Locations

199 Rosewood Dr
Ste 250
Danvers, MA 01923
Phone (978) 867-7756

12 Methuen St
Ste 3
Lawrence, MA 01840
Phone (978) 683-3128

1145 Sagamore Ave
Portsmouth, NH 03801
Phone (603) 431-6703

Organizations & group practices 3

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": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184112000000",
    "number": "1093889206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1145 SAGAMORE AVE",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038015585",
            "telephone_number": "603-431-6703",
            "fax_number": "603-430-3753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 SAGAMORE AVE",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038015585",
            "telephone_number": "603-431-6703",
            "fax_number": "603-430-3753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALLON",
        "first_name": "PAUL",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2007-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NH",
            "license": "5612N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BHN",
            "identifier": "7706655Y0NH01",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "99003227",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portsmouth, NH

Sources for this page

Verify at the official NPI Registry.