NPIMap

Organization Active NPI

Down East Orthopedic Assoc PA

  • Specialist
  • Bangor, ME
National Provider Identifier
1194763110
Registry record updated Jul 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
DOWN EAST ORTHOPEDIC ASSOC PA
Practice address
78 Ridgewood Dr
Bangor, ME 04401-2652
Phone
(207) 947-8381
Fax
(207) 942-5631
NPI assigned
Jun 3, 2006
Last updated
Jul 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2021

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

Authorized official

Name
Gerald Merrill
Title
Administrator
Phone
(207) 307-8954

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X ME Primary
Physical Therapist 225100000X ME
Occupational Therapist 225X00000X ME

Addresses

Primary practice location

78 Ridgewood Dr
Bangor, ME 04401-2652

Mailing address

78 Ridgewood Dr
Bangor, ME 04401-2652
Phone (207) 947-8381

Other identifiers 2

IdentifierTypeStateIssuer
CF4751OtherMERAIL ROAD MEDICARE GROUP
105820000MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040805000812 ME Part B Supplier - Clinic/Group Practice 4284619198 Receives reassigned benefits from 23 practitioners
Practice locations: Bangor, ME
O20100930001538 ME DME Supplier - Physician - Orthopedic/Orthopedic SurgeryDME Supplier - Independently-Practicing Physical Therapist 4284619198 Practice locations: Bangor, ME

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
20D2007782Down East Orthopedic Associates, PA78 Ridgewood Drive, Bangor, ME 04401Certificate of waiverMay 25, 2028

National Provider Directory

National Provider Directory

Locations

404 State St
Ste 610
Bangor, ME 04401
Phone (207) 947-0469

78 Ridgewood Dr
Bangor, ME 04401
Phone (207) 947-0768

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626393600000",
    "number": "1194763110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "78 RIDGEWOOD DR",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044012652",
            "telephone_number": "207-947-8381",
            "fax_number": "207-947-1897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78 RIDGEWOOD DR",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044012652",
            "telephone_number": "207-947-8381",
            "fax_number": "207-942-5631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOWN EAST ORTHOPEDIC ASSOC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2021-07-16",
        "certification_date": "2021-07-16",
        "status": "A",
        "authorized_official_last_name": "MERRILL",
        "authorized_official_first_name": "GERALD",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "207-307-8954"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "ME",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ME",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "ME",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE GROUP",
            "identifier": "CF4751",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105820000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.