Individual provider Active NPI

Jessica Susan Watson, MD

  • Ophthalmology Physician
  • Bangor, ME
National Provider Identifier
1437440435
Registry record updated Mar 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
MD21388 Issued in ME
Practice address
885 Union St Ste 130
Bangor, ME 04401-3088
Phone
(207) 973-4185
Fax
(207) 973-4187
NPI assigned
Apr 25, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X MD-42456 IA
Retina Specialist (Ophthalmology) Physician 207WX0107X MD21388 ME
Ophthalmology Physician 207W00000X MD21388 ME Primary

Addresses

Primary practice location

885 Union St Ste 130
Bangor, ME 04401-3088

Mailing address

15 Lowell Street
Portland, ME 04102-2726
Phone (207) 774-8277

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
I20170131000106 ME Practitioner - Ophthalmology 9739400524 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eastern Maine Medical CenterGroup PAC ID 2062315161, 659 clinicians

Practice addresses (Care Compare)

302 Husson Ave
Bangor, ME 04401-3374
Phone (207) 947-6141

33 Whiting Hill Rd
Brewer, ME 04412-1021
Phone (207) 973-7478

404 State St
Bangor, ME 04401-6623

489 State St
Bangor, ME 04401-6616
Phone (207) 973-7000

885 Union St
Suite 130
Bangor, ME 04401-3088
Phone (207) 973-4185

Hospital & facility affiliations

  • Northern Light Eastern Maine Medical Center Hospital, Bangor, ME, CCN 200033

Merit-based Incentive Payment System (MIPS)

Final score
84.1 of 100Reported as group
Quality
64.8
Promoting interoperability
96
Improvement activities
40
Cost
68.87

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD21388MEMDRetina Specialist (Ophthalmology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Eastern Maine Medical Center CurrentSince May 30, 2021 Accepting new patients
Eastern Maine Medical Center CurrentSince May 30, 2021 Accepting new patients

Locations

489 State St
Bangor, ME 04401
Phone (207) 973-8837

885 Union St
Ste 130
Bangor, ME 04401
Phone (207) 942-1291

489 State St
Ste A
Bangor, ME 04401

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1303689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646956800000",
    "number": "1437440435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 LOWELL STREET",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022726",
            "telephone_number": "207-774-8277",
            "fax_number": "207-699-5850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "885 UNION ST STE 130",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013088",
            "telephone_number": "207-973-4185",
            "fax_number": "207-973-4187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "JESSICA",
        "middle_name": "SUSAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-25",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IA",
            "license": "MD-42456",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Retina Specialist",
            "state": "ME",
            "license": "MD21388",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "ME",
            "license": "MD21388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.