NPIMap

Individual provider Active NPI

Samuel Gagnon, PA-C

  • Physician Assistant
  • South Portland, ME
National Provider Identifier
1407121932
Registry record updated Jun 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA1456 Issued in ME
Practice address
265 Western Ave Ste 2
South Portland, ME 04106-2458
Phone
(207) 661-0200
Fax
(207) 661-0299
NPI assigned
Mar 16, 2012
Last updated
Jun 14, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA1456 ME Primary

Addresses

Primary practice location

265 Western Ave Ste 2
South Portland, ME 04106-2458

Mailing address

265 Western Ave Ste 2
South Portland, ME 04106-2458
Phone (207) 661-0200

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
I20140707000717 ME Practitioner - Physician Assistant 4082878327 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

100 Campus Dr
Scarborough, ME 04074-7172

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

265 Western Ave
Suite 2
South Portland, ME 04106-2458
Phone (207) 396-7606

Hospital & facility affiliations

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)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Nov 27, 2017 Accepting new patients
Maine Medical Partners CurrentSince Apr 1, 2021 Accepting new patients
Maine Medical Partners CurrentSince Nov 27, 2017 Accepting new patients
Maine Medical Partners CurrentSince Nov 27, 2017 Accepting new patients
Mainehealth CurrentSince Nov 27, 2017 Accepting new patients

Locations

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

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

49 Spring St
Scarborough, ME 04074
Phone (207) 883-1414

265 Western Ave
Ste 2
South Portland, ME 04106
Phone (207) 661-0200

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

Interoperability endpoints

  • Direct secure messaging: sgagnon198270@direct.mmc.mainehealth.org

Organizations & group practices 8

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.

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": "1331856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1407121932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "265 WESTERN AVE STE 2",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041062458",
            "telephone_number": "207-661-0200",
            "fax_number": "207-661-0299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "265 WESTERN AVE STE 2",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041062458",
            "telephone_number": "207-661-0200",
            "fax_number": "207-661-0299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAGNON",
        "first_name": "SAMUEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-16",
        "last_updated": "2021-06-14",
        "certification_date": "2021-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA1456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Portland, ME

Sources for this page

Verify at the official NPI Registry.