Rezeda Y. Zinyatullova, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA2422 Issued in ME

Practice address

84 Marginal Way Ste 700
Portland, ME 04101-2481

Phone

(207) 774-5816

NPI assigned

Sep 16, 2022

Last updated

Feb 21, 2024By the provider in NPPES

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

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

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Convenientmd - FFS UC LLCGroup PAC ID 5193186492, 397 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Convenientmd - FFS UC LLC

  • Urgent Care Clinic/Center
  • Ellsworth, ME
  • NPI 1780375220
  Medicare reassignment Care Compare group
• Intermed, PA

  • Internal Medicine Physician
  • South Portland, ME
  • NPI 1467422733
  Medicare reassignment NPD
• Convenientmd - FFS UC LLC

  • Urgent Care Clinic/Center
  • Saco, ME
  • NPI 1114618659
  NPD
• Intermed, PA

  • Pediatrics Physician
  • South Portland, ME
  • NPI 1295607836
  NPD
• Convenientmd - FFS UC LLC

  • Urgent Care Clinic/Center
  • Sturbridge, MA
  • NPI 1386526192
  NPD

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

{
    "created_epoch": "1663286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708473600000",
    "number": "1205558129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 GANNETT DR STE C",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041065900",
            "telephone_number": "207-828-0361",
            "fax_number": "207-874-1483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "84 MARGINAL WAY STE 700",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041012481",
            "telephone_number": "207-774-5816"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "506 Main St",
            "address_purpose": "LOCATION",
            "city": "Saco",
            "state": "ME",
            "postal_code": "040721530",
            "country_code": "US",
            "telephone_number": "207-571-7991",
            "fax_number": "207-571-7990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZINYATULLOVA",
        "first_name": "REZEDA",
        "middle_name": "Y.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-16",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA2422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madolynne Zimmerman, PNP
• Michelle Zimmerman, LCSW
• Ryan C Zimmerman, PA-C
• Evan Michael Zink, MD
• Rebecca Zinkowski, RD, LD, CNSC
• Dorothy Elizabeth Zirkle, AGNP-BC
• Raymond Christopher Zito, LCSW
• Ariel Porterfield Zodhiates, M.D.
• Zoe Eiber LLC
• Eden J. Zoll, DO

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2024; 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.
• 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.