Individual provider Active NPI

Melissa Lynn Pederson, PA

  • Medical Physician Assistant
  • Lewiston, ME
National Provider Identifier
1336491265
Registry record updated Jul 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
60 High St
Lewiston, ME 04240-7616
Phone
(207) 753-3900
Fax
(207) 753-3902
NPI assigned
Oct 2, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X Primary

Addresses

Primary practice location

60 High St
Lewiston, ME 04240-7616

Mailing address

8 Red Oak Dr
Falmouth, ME 04105-2595
Phone (509) 571-5484

Other practice location 1

545 N River St Ste 240
Wilkes Barre, PA 18702-2643
Phone (570) 819-2825

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mpederson1109621@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20171204002310 WI Practitioner - Physician Assistant 1759534522 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MCHS Hospitals IncGroup PAC ID 5698071173, 1,195 clinicians

Practice addresses (Care Compare)

1000 N Oak Ave
Marshfield, WI 54449-5703
Phone (715) 387-5511

Hospital & facility affiliations

  • Marshfield Medical Center Hospital, Marshfield, WI, CCN 520037

Merit-based Incentive Payment System (MIPS)

Final score
83.6 of 100Reported as group
Quality
62.55
Promoting interoperability
100
Improvement activities
40
Cost
76.03

Merit-based Incentive Payment System (MIPS)

Final score
89.17 of 100Reported as apm
Quality
78.34
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
80.58 of 100Reported as group
Quality
55.5
Promoting interoperability
100
Improvement activities
40
Cost
71.46

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
MCHS Hospitals Inc CurrentSince Jun 17, 2024 Accepting new patients
Lakeview Medical Center Inc of Rice Lake CurrentSince Jun 17, 2024 Accepting new patients
Lakeview Medical Center Inc of Rice Lake CurrentSince Jun 17, 2024 Accepting new patients
Beaver Dam Community Hospitals Inc CurrentSince Jun 17, 2024 Accepting new patients
Flambeau Hospital Inc CurrentSince Jun 17, 2024 Accepting new patients
Marshfield Clinic Inc CurrentSince Jun 17, 2024 Accepting new patients
Memorial Hospital Inc CurrentSince Jun 17, 2024 Accepting new patients
MCHS Hospitals Inc CurrentSince Jun 17, 2024 Accepting new patients
Flambeau Hospital Inc CurrentSince Jun 17, 2024 Accepting new patients

Locations

705 S University Ave
Beaver Dam, WI 53916
Phone (920) 885-6090

3501 Golf Rd
Eau Claire, WI 54701
Phone (715) 858-4200

1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5111

1102 S Center Ave
Merrill, WI 54452
Phone (715) 536-3399

N3708 River Ave
Neillsville, WI 54456
Phone (715) 743-3101

1700 W Stout St
Rice Lake, WI 54868
Phone (715) 236-6133

Interoperability endpoints

  • Direct secure messaging: mpederson1109621@wm.providencedirect.org

Organizations & group practices 10

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 1

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": "1349136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689033600000",
    "number": "1336491265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 RED OAK DR",
            "city": "FALMOUTH",
            "state": "ME",
            "postal_code": "041052595",
            "telephone_number": "509-571-5484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 HIGH ST",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042407616",
            "telephone_number": "207-753-3900",
            "fax_number": "207-753-3902"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "545 N River St Ste 240",
            "address_purpose": "LOCATION",
            "city": "Wilkes Barre",
            "state": "PA",
            "postal_code": "187022643",
            "country_code": "US",
            "telephone_number": "570-819-2825",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "MELISSA",
        "middle_name": "LYNN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-02",
        "last_updated": "2023-07-11",
        "certification_date": "2023-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mpederson1109621@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1100 Goethals Dr Ste F",
            "city": "Richland",
            "state": "WA",
            "country_code": "US",
            "postal_code": "99352",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lewiston, ME

Sources for this page

Verify at the official NPI Registry.