Individual provider Active NPI

Lyudmila A Gazder, NP

  • Nurse Practitioner
  • Bangor, ME
National Provider Identifier
1225552722
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
CNP171107 Issued in ME
Practice address
417 State St Ste 400
Bangor, ME 04401-6639
Phone
(207) 942-6096
Fax
(207) 973-8857
NPI assigned
Jul 27, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X CNP171107 ME Primary

Addresses

Primary practice location

417 State St Ste 400
Bangor, ME 04401-6639

Mailing address

417 State St Ste 400
Bangor, ME 04401-6639
Phone (207) 942-6096

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
I20170907001109 ME Practitioner - Nurse Practitioner 1052684487 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Eastern Maine Medical CenterGroup PAC ID 2062315161, 659 clinicians

Practice addresses (Care Compare)

404 State St
Bangor, ME 04401-6623

417 State St
Suite 20
Bangor, ME 04401-6637
Phone (207) 275-1500

489 State St
Bangor, ME 04401-6616
Phone (207) 973-7000

885 Union St
Suite 245
Bangor, ME 04401-3090
Phone (207) 973-6584

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.1 of 100Reported as group
Quality
64.8
Promoting interoperability
96
Improvement activities
40
Cost
68.87

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Eastern Maine Medical Center CurrentSince Feb 5, 2023 Accepting new patients
Eastern Maine Medical Center CurrentSince Feb 5, 2023 Accepting new patients

Locations

489 State St
Bangor, ME 04401
Phone (207) 973-8837

417 State St
Ste 400
Bangor, ME 04401
Phone (207) 942-6096

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1501113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1225552722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 STATE ST STE 400",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016639",
            "telephone_number": "207-942-6096",
            "fax_number": "207-973-8857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 STATE ST STE 400",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016639",
            "telephone_number": "207-942-6096",
            "fax_number": "207-973-8857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAZDER",
        "first_name": "LYUDMILA",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-27",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ME",
            "license": "CNP171107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.