Meredith Bryden Jackson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD21911 Issued in ME

Practice address

22 Bramhall St
Portland, ME 04102

Phone

(207) 662-0111

NPI assigned

Mar 25, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Meredith Raibley Bryden Former name

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mbryden99123@direct.mmc.mainehealth.org

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.

• Mainehealth

  • Psychiatric Hospital
  • Westbrook, ME
  • NPI 1790265502
  Medicare reassignment NPD
• Mainehealth

  • Community/Retail Pharmacy
  • Portland, ME
  • NPI 1013868181
  NPD
• Mainehealth

  • General Acute Care Hospital
  • Portland, ME
  • NPI 1760436216
  NPD

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

{
    "created_epoch": "1427241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563235200000",
    "number": "1174917439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 BRAMHALL ST STE 4809",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023134",
            "telephone_number": "207-662-5675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 BRAMHALL ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04102",
            "telephone_number": "207-662-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MEREDITH",
        "middle_name": "BRYDEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-25",
        "last_updated": "2019-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ME",
            "license": "MD21911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MEREDITH",
            "last_name": "BRYDEN",
            "middle_name": "RAIBLEY",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David Yarnall Jackson, DO
• Elizabeth A Jackson, LIC. MASSAGE THERAPI
• Emily Jackson, M.S. CCC-SLP
• Heather M. Jackson, LCSW
• James E Jackson, DMD
• Ryan Christopher Jackson, MD
• Sydney Michael Emily Jackson, RPH
• Tara Jackson, CPO
• Jacobs Chiropractic Acupuncture, P.a.
• Chester Jacobs, DO

• Pediatrics Physician in Portland, ME
• Providers in Portland, ME by specialty
• Pediatrics Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.