Active NPI
Sean Michael Etheridge, PA-C
- Physician Assistant
- Scarborough, ME
National Provider Identifier
1215547716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA2612
- Practice address
- 92 Campus Dr Ste C
Scarborough, ME 04074-7229 - Phone
- (207) 797-5753
- NPI assigned
- Aug 9, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA2612 | ME | Primary |
Addresses
Primary practice location
92 Campus Dr Ste C
Scarborough, ME 04074-7229
Mailing address
38 Academy Cir
Oakland, NJ 07436-2625
Phone (201) 783-5471
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ, ME
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
22 Bramhall St
Portland, ME 04102-3134
Phone (207) 885-9905
92 Campus Dr
Scarborough, ME 04074-7229
Hospital & facility affiliations
- Mainehealth Maine Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 97.93 of 100
- Quality
- 83.31
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA2612 | ME | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mainehealth | Current | Accepting new patients | |
| Mainehealth | Current | Accepting new patients | |
| Mainehealth | Past | Accepting new patients |
Locations
22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179
92 Campus Dr
Ste C
Scarborough, ME 04074
Phone (207) 797-5753
Interoperability endpoints
- setheridge878868@direct.mmc.mainehealth.org
Organizations & group practices 5
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.
-
- Psychiatric Hospital
- Westbrook, ME
- NPI 1790265502
-
- Hospitalist Physician
- New Brunswick, NJ
- NPI 1902848625
-
- Community/Retail Pharmacy
- Portland, ME
- NPI 1013868181
-
- General Acute Care Hospital
- Portland, ME
- NPI 1508897059
-
- Clinic/Center
- Portland, ME
- NPI 1487346722
Hospital & facility affiliations 36
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Scarborough, ME
- NPI 1053647024
-
- General Acute Care Hospital
- Portland, ME
- NPI 1346267879
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720483200000",
"number": "1215547716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38 ACADEMY CIR",
"city": "OAKLAND",
"state": "NJ",
"postal_code": "074362625",
"telephone_number": "201-783-5471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "92 CAMPUS DR STE C",
"city": "SCARBOROUGH",
"state": "ME",
"postal_code": "040747229",
"telephone_number": "207-797-5753"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETHERIDGE",
"first_name": "SEAN",
"middle_name": "MICHAEL",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-09",
"last_updated": "2024-07-09",
"certification_date": "2024-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ME",
"license": "PA2612",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Scarborough, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.