Individual provider Active NPI

Nathaniel Anderson

  • Gerontology Nurse Practitioner
  • Yarmouth, ME
National Provider Identifier
1336696590
Registry record updated Sep 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
CNP161101 Issued in ME
Practice address
266 E Elm St
Yarmouth, ME 04096-7116
Phone
(207) 232-9105
NPI assigned
Sep 6, 2016
Last updated
Sep 11, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X CNP161101 ME Primary

Addresses

Primary practice location

266 E Elm St
Yarmouth, ME 04096-7116

Mailing address

266 E Elm St
Yarmouth, ME 04096-7116

Other names 1

  • Nath Anderson Other name

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
I20161007000842 ME Practitioner - Nurse Practitioner 8123316189 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
81.67 of 100Reported as group
Quality
60.7
Promoting interoperability
91
Improvement activities
40
Cost
73.8

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CNP161101MEMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital CurrentSince Dec 10, 2021 Accepting new patients
Mercy Hospital CurrentSince Dec 10, 2021 Accepting new patients
Mercy Hospital Past Accepting new patients

Locations

93 Campus Ave
Lewiston, ME 04240
Phone (207) 755-3715

40 Park Rd
Westbrook, ME 04092
Phone (207) 857-8174

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1473120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599782400000",
    "number": "1336696590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "266 E ELM ST",
            "city": "YARMOUTH",
            "state": "ME",
            "postal_code": "040967116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "266 E ELM ST",
            "city": "YARMOUTH",
            "state": "ME",
            "postal_code": "040967116",
            "telephone_number": "207-232-9105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "NATHANIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-06",
        "last_updated": "2020-09-11",
        "certification_date": "2020-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "ME",
            "license": "CNP161101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NATH",
            "last_name": "ANDERSON",
            "credential": "N.P.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Yarmouth, ME

Sources for this page

Verify at the official NPI Registry.