Individual provider Active NPI

Mackenzie Ann Bancroft

  • Physician Assistant
  • Waterville, ME
National Provider Identifier
1194423251
Registry record updated Apr 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2650 Issued in ME
Practice address
211 Main St
Waterville, ME 04901-6117
Phone
(207) 877-3400
Fax
(207) 877-3401
NPI assigned
Feb 20, 2023
Last updated
Apr 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA2650 ME Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

211 Main St
Waterville, ME 04901-6117

Mailing address

211 Main St
Waterville, ME 04901-6117
Phone (207) 877-3400

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
I20240415002318 ME Practitioner - Physician Assistant 2961841697 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Tufts University School of Medicine, 2024
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

211 Main St
Waterville, ME 04901-6117
Phone (207) 877-3400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA2650MEMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mainegeneral Medical Center CurrentSince May 6, 2024 Accepting new patients
Mainegeneral Medical Center CurrentSince May 6, 2024 Accepting new patients

Locations

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

211 Main St
Waterville, ME 04901
Phone (207) 877-3400

Interoperability endpoints

  • Direct secure messaging: mackenziebancroft@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": "1676851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712793600000",
    "number": "1194423251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 MAIN ST",
            "city": "WATERVILLE",
            "state": "ME",
            "postal_code": "049016117",
            "telephone_number": "207-877-3400",
            "fax_number": "207-877-3401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 MAIN ST",
            "city": "WATERVILLE",
            "state": "ME",
            "postal_code": "049016117",
            "telephone_number": "207-877-3400",
            "fax_number": "207-877-3401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANCROFT",
        "first_name": "MACKENZIE",
        "middle_name": "ANN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-20",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA2650",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterville, ME

Sources for this page

Verify at the official NPI Registry.