NPIMap

Individual provider Active NPI

Jessica Esther Radway, PA-C

  • Specialist
  • Portland, ME
National Provider Identifier
1194020891
Registry record updated Sep 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
PA1564 Issued in ME
Practice address
51 Sewall St Ste 1
Portland, ME 04102
Phone
(207) 774-5761
Fax
(207) 874-7478
NPI assigned
Jan 11, 2011
Last updated
Sep 26, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA161551 OR
Student in an Organized Health Care Education/Training Program 390200000X N/A
Specialist 174400000X PA1564 ME Primary

Addresses

Primary practice location

51 Sewall St Ste 1
Portland, ME 04102

Mailing address

51 Sewall St Ste 1
Portland, ME 04102-2697
Phone (207) 774-5761

Other practice location 1

16770 SW Edy Rd
Sherwood, OR 97140-9678
Phone (503) 216-9600

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220930002454 ME Practitioner - Physician Assistant 7214173350 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rheumatology Associates P.a.Group PAC ID 5395793541, 10 clinicians

Practice addresses (Care Compare)

51 Sewall St
Portland, ME 04102-2643
Phone (207) 774-5761

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mainegeneral Health Associates 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 42

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1294704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537920000000",
    "number": "1194020891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 SEWALL ST STE 1",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022697",
            "telephone_number": "207-774-5761",
            "fax_number": "207-874-7478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 SEWALL ST STE 1",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04102",
            "telephone_number": "207-774-5761",
            "fax_number": "207-874-7478"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16770 SW Edy Rd",
            "address_purpose": "LOCATION",
            "city": "Sherwood",
            "state": "OR",
            "postal_code": "971409678",
            "country_code": "US",
            "telephone_number": "503-216-9600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RADWAY",
        "first_name": "JESSICA",
        "middle_name": "ESTHER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-11",
        "last_updated": "2018-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA161551",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": "N/A",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "ME",
            "license": "PA1564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.