Individual provider Active NPI

Amie Fagan, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Waterville, ME
National Provider Identifier
1114687480
Registry record updated Dec 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
CNP211610 Issued in ME
Practice address
149 North St
Waterville, ME 04901-4974
Phone
(207) 873-1098
Fax
(207) 861-5461
NPI assigned
Dec 28, 2021
Last updated
Dec 28, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X CNP211610 ME Primary

Addresses

Primary practice location

149 North St
Waterville, ME 04901-4974

Mailing address

149 North St
Waterville, ME 04901-4974
Phone (207) 873-1098

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
I20220201001999 ME Practitioner - Nurse Practitioner 6204229909 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mainegeneral Medical CenterGroup PAC ID 1254245715, 554 clinicians

Practice addresses (Care Compare)

149 N St
Waterville, ME 04901
Phone (207) 872-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.22 of 100Reported as group
Quality
75.39
Promoting interoperability
84
Improvement activities
40
Cost
75.32

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mainegeneral Medical Center CurrentSince Jan 3, 2022 Accepting new patients
Mainegeneral Medical Center CurrentSince Jan 3, 2022 Accepting new patients

Locations

149 North St
Waterville, ME 04901
Phone (207) 622-1959

Interoperability endpoints

  • Direct secure messaging: amiefagan@mgh.allscriptsdirect.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1640649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640649600000",
    "number": "1114687480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 NORTH ST",
            "city": "WATERVILLE",
            "state": "ME",
            "postal_code": "049014974",
            "telephone_number": "207-873-1098",
            "fax_number": "207-861-5461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 NORTH ST",
            "city": "WATERVILLE",
            "state": "ME",
            "postal_code": "049014974",
            "telephone_number": "207-873-1098",
            "fax_number": "207-861-5461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "AMIE",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-28",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ME",
            "license": "CNP211610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterville, ME

Sources for this page

Verify at the official NPI Registry.