NPIMap

Individual provider Active NPI

Ellen B Jankowski, PA-C

  • Physician Assistant
  • Portland, ME
National Provider Identifier
1417963109
Registry record updated Sep 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA001161 Issued in ME
Practice address
84 Marginal Way
Suite 700
Portland, ME 04101
Phone
(207) 774-5816
Fax
(207) 523-8597
NPI assigned
Aug 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA10004431 WA
Medical Physician Assistant 363AM0700X PA10004431 WA
Medical Physician Assistant 363AM0700X PA001161 ME
Physician Assistant 363A00000X PA001161 ME Primary

Addresses

Primary practice location

84 Marginal Way
Suite 700
Portland, ME 04101

Mailing address

100 Gannett Dr
Suite C
South Portland, ME 04106-5900
Phone (207) 828-0361

Other identifiers 4

IdentifierTypeStateIssuer
0166563OtherWAL&I PIN
272170099MedicaidME
8324659MedicaidWA
54807UOtherWAREGENCE BLUE SHIELD PIN

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
I20090507000580 ME Practitioner - Physician Assistant 8729171236 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
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)

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

96 Campus Dr
Scarborough, ME 04074-7163
Phone (207) 885-9905

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA001161MEMDMedical Physician Assistant
PA10004431WAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Oct 1, 2020 Accepting new patients
Maine Medical Partners CurrentSince Oct 1, 2020 Accepting new patients
Maine Medical Partners CurrentSince Oct 1, 2020 Accepting new patients
Maine Medical Partners Medical CurrentSince Mar 20, 2023 Accepting new patients
Intermed, PA CurrentSince Mar 3, 2014 Accepting new patients
Mainehealth CurrentSince Oct 1, 2020 Accepting new patients
Intermed, PA CurrentSince Mar 3, 2014 Accepting new patients
Maine Medical Partners CurrentSince Jul 1, 2020 Accepting new patients
Maine Medical Partners Physician Assistant CurrentSince Jul 1, 2020 Accepting new patients
Maine Medical Partners CurrentSince Nov 5, 2023 Accepting new patients

Locations

887 Congress St
Ste 200
Portland, ME 04102
Phone (207) 771-5549

84 Marginal Way
Ste 700
Portland, ME 04101
Phone (207) 347-2898

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

100 Campus Dr
Unit 107
Scarborough, ME 04074
Phone (207) 396-7565

96 Campus Dr
Ste 2B
Scarborough, ME 04074
Phone (207) 883-3491

100 Gannett Dr
Ste C
South Portland, ME 04106
Phone (207) 523-3649

100 Foden Rd
Ste W-100
South Portland, ME 04106
Phone (207) 523-3900

100 Foden Rd
Ste 100
South Portland, ME 04106
Phone (207) 874-1489

1 Harnois Ave
Ste 1A
Westbrook, ME 04092
Phone (207) 662-1360

1 Harnois Ave
Ste 2
Westbrook, ME 04092
Phone (207) 661-3400

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

Interoperability endpoints

  • Direct secure messaging: ejankowski9789@direct.mmc.mainehealth.org

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 40

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

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601078400000",
    "number": "1417963109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 GANNETT DR",
            "address_2": "SUITE C",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041065900",
            "telephone_number": "207-828-0361",
            "fax_number": "207-874-1483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "84 MARGINAL WAY",
            "address_2": "SUITE 700",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04101",
            "telephone_number": "207-774-5816",
            "fax_number": "207-523-8597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANKOWSKI",
        "first_name": "ELLEN",
        "middle_name": "B",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2020-09-26",
        "certification_date": "2020-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10004431",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10004431",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ME",
            "license": "PA001161",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA001161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I PIN",
            "identifier": "0166563",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "272170099",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8324659",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD PIN",
            "identifier": "54807U",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.