Individual provider Active NPI

Theresa Holden

  • Physician Assistant
  • Waterville, ME
National Provider Identifier
1417621004
Registry record updated Aug 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2206 Issued in ME
Practice address
149 North St
Waterville, ME 04901-4974
Phone
(207) 861-5000
Fax
(207) 861-5001
NPI assigned
Aug 6, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 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 PA2206 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

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
I20210817003075 ME Practitioner - Physician Assistant 2466857297 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of New England, College of Osteo Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mainegeneral Medical CenterGroup PAC ID 1254245715, 554 clinicians

Practice addresses (Care Compare)

149 N St
Waterville, ME 04901
Phone (207) 872-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.22 of 100Reported as group
Quality
75.39
Promoting interoperability
84
Improvement activities
40
Cost
75.32

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA2206MEMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mainegeneral Medical Center CurrentSince Aug 2, 2021 Accepting new patients
Mainegeneral Medical Center Physician Assistant CurrentSince Aug 2, 2021 Accepting new patients
Mainegeneral Medical Center Past Accepting new patients

Locations

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

149 North St
Unit 8B
Waterville, ME 04901

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1628208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628208000000",
    "number": "1417621004",
    "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": "HOLDEN",
        "first_name": "THERESA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-06",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA2206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterville, ME

Sources for this page

Verify at the official NPI Registry.