NPIMap

Individual provider Active NPI

Amanda Kathryn Keene, PA-C

  • Surgical Physician Assistant
  • South Portland, ME
National Provider Identifier
1366909103
Registry record updated Feb 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA1902 Issued in ME
Practice address
119 Gannett Dr
South Portland, ME 04106-6942
Phone
(207) 773-0040
Fax
(207) 661-4630
NPI assigned
Feb 28, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA1902 ME
Surgical Physician Assistant 363AS0400X PA1902 ME Primary

Addresses

Primary practice location

119 Gannett Dr
South Portland, ME 04106-6942

Mailing address

119 Gannett Dr
South Portland, ME 04106-6942
Phone (207) 773-0040

Other names 1

  • Amanda Kathryn Connell Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190410002476 ME Practitioner - Physician Assistant 6608117114 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Yale University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

119 Gannett Dr
South Portland, ME 04106-6942
Phone (207) 773-0040

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 885-9905

265 Western Ave
1 MMP Dermatology
South Portland, ME 04106-6942
Phone (207) 661-0100

84 Campus Dr
Scarborough, ME 04074-7133
Phone (207) 396-7000

Hospital & facility affiliations

  • Mainehealth Maine Medical Center Hospital, Portland, ME, CCN 200009

Merit-based Incentive Payment System (MIPS)

Final score
97.93 of 100Reported as apm
Quality
83.31
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA1902MEMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Maine Medical Partners CurrentSince Mar 3, 2019 Accepting new patients
Mainehealth CurrentSince Mar 3, 2019 Accepting new patients
Mainehealth CurrentSince Mar 3, 2019 Accepting new patients
Mainehealth Past Accepting new patients

Locations

887 Congress St
Ste 210
Portland, ME 04102
Phone (207) 774-2381

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

119 Gannett Dr
South Portland, ME 04106
Phone (207) 773-0040

584 Roosevelt Trl
Windham, ME 04062
Phone (207) 892-3216

582 Roosevelt Trl
Windham, ME 04062
Phone (207) 892-3233

Interoperability endpoints

  • Direct secure messaging: aconnell249283@direct.mmc.mainehealth.org

Organizations & group practices 6

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 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1551312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582070400000",
    "number": "1366909103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 GANNETT DR",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041066942",
            "telephone_number": "207-773-0040",
            "fax_number": "207-661-4630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 GANNETT DR",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041066942",
            "telephone_number": "207-773-0040",
            "fax_number": "207-661-4630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEENE",
        "first_name": "AMANDA",
        "middle_name": "KATHRYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-28",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ME",
            "license": "PA1902",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "ME",
            "license": "PA1902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "CONNELL",
            "middle_name": "KATHRYN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in South Portland, ME

Sources for this page

Verify at the official NPI Registry.