Shellyann Wall, P.A.-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA2003 Issued in ME

Practice address

118 Northport Ave
Belfast, ME 04915-6009

Phone

(207) 338-2500

Fax

(207) 505-4590

NPI assigned

Jul 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mainehealth Waldo Hospital Hospital, Belfast, ME, CCN 201312

Merit-based Incentive Payment System (MIPS)

Final score

97.93 of 100Reported as apm

Quality

83.31

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: swall283471@direct.mmc.mainehealth.org

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.

• Mainehealth

  • Critical Access Hospital
  • Belfast, ME
  • NPI 1841397932
  Medicare reassignment Care Compare group NPD
• Hospital Medicine Services of Maine LLC

  • Hospitalist Physician
  • Ellsworth, ME
  • NPI 1538638432
  Medicare reassignment
• Maine Medical Services LLC

  • Hospitalist Physician
  • Ellsworth, ME
  • NPI 1053878371
  Medicare reassignment
• Mainehealth

  • Psychiatric Hospital
  • Westbrook, ME
  • NPI 1790265502
  Medicare reassignment
• Mainehealth

  • Community/Retail Pharmacy
  • Portland, ME
  • NPI 1013868181
  NPD
• Mainehealth

  • Surgery Physician
  • Portland, ME
  • NPI 1376981993
  NPD
• Carolina Digestive Health Associates, PA

  • Gastroenterology Physician
  • Charlotte, NC
  • NPI 1124052444
  NPD
• Carolina Digestive Health Associates, PA

  • Ambulatory Surgical Clinic/Center
  • Charlotte, NC
  • NPI 1063584415
  NPD (past)

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

• Mainehealth

  • Critical Access Hospital
  • Belfast, ME
  • NPI 1841397932
  Care Compare affiliation

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1235157488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 SOUTHSIDE AVE",
            "address_2": "SUITE 350",
            "city": "ASHEVILLE",
            "state": "NC",
            "postal_code": "288014160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 NORTHPORT AVE",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049156009",
            "telephone_number": "207-338-2500",
            "fax_number": "207-505-4590"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10648 Park Rd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282108407",
            "country_code": "US",
            "telephone_number": "704-667-8050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALL",
        "first_name": "SHELLYANN",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103723",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA2003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235157488",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Waldo County Home Healthcare Services
• Waldo County Home Healthcare Services
• Walgreen Co
• Walgreen Eastern Co Inc
• Matthew Wall, DO
• Marjorie A. Walsh, LCSW
• Silas DK Walsh, LCSW
• Waltz Pharmacy, Inc
• Heather M Ward, MD
• Debora D. Waring, PSY.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.