Individual provider Active NPI

William Cochran McDougall IV, DO

  • Neuromusculoskeletal Medicine & OMM Physician
  • Waterville, ME
National Provider Identifier
1417336603
Registry record updated Aug 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X
License
DO2837 Issued in ME
Practice address
149 North St
Waterville, ME 04901-4974
Phone
(207) 861-5000
Fax
(207) 861-5001
NPI assigned
May 21, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X TP15057 ME
Emergency Medicine Physician 207P00000X DO2837 ME
Neuromusculoskeletal Medicine & OMM Physician 204D00000X DO2837 ME Primary

Addresses

Primary practice location

149 North St
Waterville, ME 04901-4974

Mailing address

149 North St
Waterville, ME 04901-4974
Phone (207) 861-5000

Other identifiers 1

IdentifierTypeStateIssuer
1417336603MedicaidME

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190815001865 ME Practitioner - Osteopathic Manipulative Medicine 5991092819 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
DO2837MEMDEmergency Medicine Physician
TP15057MEMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Mainegeneral Medical Center CurrentSince Jul 29, 2019 Accepting new patients
Mainegeneral Medical Center CurrentSince Jul 29, 2019 Accepting new patients

Locations

149 North St
Waterville, ME 04901
Phone (207) 622-1959

Interoperability endpoints

  • Direct secure messaging: wmcdougall260051@direct.mmc.mainehealth.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1432166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564617600000",
    "number": "1417336603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 NORTH ST",
            "city": "WATERVILLE",
            "state": "ME",
            "postal_code": "049014974",
            "telephone_number": "207-861-5000",
            "fax_number": "207-861-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 NORTH ST",
            "city": "WATERVILLE",
            "state": "ME",
            "postal_code": "049014974",
            "telephone_number": "207-861-5000",
            "fax_number": "207-861-5001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDOUGALL",
        "first_name": "WILLIAM",
        "middle_name": "COCHRAN",
        "name_suffix": "IV",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-21",
        "last_updated": "2019-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "ME",
            "license": "TP15057",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ME",
            "license": "DO2837",
            "primary": false
        },
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "ME",
            "license": "DO2837",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417336603",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterville, ME

Sources for this page

Verify at the official NPI Registry.