David Wallstrom, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA2300 Issued in ME

Practice address

22 Station Ave
Brunswick, ME 04011-2092

Phone

(207) 406-7500

NPI assigned

Mar 21, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mainehealth Mid Coast Hospital Hospital, Brunswick, ME, CCN 200021

Merit-based Incentive Payment System (MIPS)

Final score

97.93 of 100Reported as apm

Quality

83.31

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dwallstrom460393@direct.mmc.mainehealth.org

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.

• Mainehealth

  • Psychiatric Hospital
  • Westbrook, ME
  • NPI 1790265502
  Medicare reassignment Care Compare group
• Bluewater Emergency Partners of Brunswick, LLC

  • Emergency Medicine Physician
  • Brunswick, ME
  • NPI 1043640204
  Medicare reassignment
• Mainehealth

  • Community/Retail Pharmacy
  • Portland, ME
  • NPI 1013868181
  NPD
• Mainehealth

  • Gynecology Physician
  • South Portland, ME
  • NPI 1679887400
  NPD
• Bluewater Emergency Partners of Calais, LLC Dba: Bluewater Urgent Care

  • Emergency Medicine Physician
  • Brunswick, ME
  • NPI 1881974665
  NPD (past)

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

• Mainehealth

  • General Acute Care Hospital
  • Brunswick, ME
  • NPI 1932164795
  Care Compare affiliation

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

{
    "created_epoch": "1490054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684454400000",
    "number": "1427589670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 ALLEN STREET",
            "address_2": "MEDICAL STAFF SERVICES",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "05701",
            "telephone_number": "802-747-3639",
            "fax_number": "802-747-6207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 STATION AVE",
            "city": "BRUNSWICK",
            "state": "ME",
            "postal_code": "040112092",
            "telephone_number": "207-406-7500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "160 Allen Street",
            "address_2": "Emergency Department",
            "address_purpose": "LOCATION",
            "city": "Rutland",
            "state": "VT",
            "postal_code": "05701",
            "country_code": "US",
            "telephone_number": "802-747-3601",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "123 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Brunswick",
            "state": "ME",
            "postal_code": "040112652",
            "country_code": "US",
            "telephone_number": "207-373-6800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLSTROM",
        "first_name": "DAVID",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-21",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ME",
            "license": "PA2300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Walden, LCPC
• Walgreen Eastern Co Inc
• Elizabeth T Wall, D.O.
• Alexis G Waller, MS, MDIV, THD, LCPCC
• Kimberly Diane Wallingford
• Laura Walsh, CRNA
• Michaela Walsh, PHD
• Melissa A Walters, PA-C
• Julia B Waltman, LCPC-C
• Scott H Walton, PAC

• Medical Physician Assistant in Brunswick, ME
• Providers in Brunswick, ME by specialty
• Medical Physician Assistant in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.