Kaitlyn Rullo
Individual provider Active NPI Urology Physician · Bangor, ME
NPI 1295465409 · NPPES record last updated Sep 21, 2023
Key facts
- NPI
- 1295465409
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Urology Physician 208800000X
- License
- PA2440 (ME)
- Practice address
- 55 Broadway
Bangor, ME 04401-5201 - Phone
- (207) 947-0469
- Fax
- (207) 947-5368
- NPI assigned
- Jun 13, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Eastern Maine Medical Center
Practice addresses (Care Compare)
302 Husson Ave
Bangor, ME 04401-3374
Phone (207) 947-6141
417 State St
Suite 20
Bangor, ME 04401-6637
Phone (207) 275-1500
489 State St
Bangor, ME 04401-6616
Phone (207) 973-7000
55 Broadway
Suite 2
Bangor, ME 04401-5201
Phone (207) 947-0469
Hospital & facility affiliations
- Northern Light Eastern Maine Medical Center
- Northern Light Sebasticook Valley Hospital
- St Joseph Hospital
- Northern Light Maine Coast Hospital
- Northern Light Blue Hill Memorial Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 84.1 of 100
- Quality
- 64.8
- Promoting interoperability
- 96
- Improvement activities
- 40
- Cost
- 68.87
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230216001970 | ME | Practitioner - Physician Assistant | 3779955968 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eastern Maine Medical Center | Current |
Accepting new patients |
Locations
489 State St
Bangor, ME 04401
Phone (207) 973-8837
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | |||
| Urology Physician | 208800000X | PA2440 | ME | Yes |
Addresses
Primary practice location
55 Broadway
Bangor, ME 04401-5201
Mailing address
489 State St
Bangor, ME 04401-6616
Other practice location 1
489 State St
Bangor, ME 04401-6616
Phone (207) 947-0469
Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.