Individual provider Active NPI

Katherine P Guiou, PAC

  • Physician Assistant
  • Bangor, ME
National Provider Identifier
1457095010
Registry record updated Nov 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2450 Issued in ME
Practice address
1012 Union St
Bangor, ME 04401-3060
Phone
(207) 404-8100
Fax
(207) 947-0435
NPI assigned
Apr 20, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2023

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 PA2450 ME Primary

Addresses

Primary practice location

1012 Union St
Bangor, ME 04401-3060

Mailing address

PO Box 1599
Bangor, ME 04402-1599
Phone (207) 404-8200

Other names 1

  • Katherine Pelletier Former name

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
I20221115002325 ME Practitioner - Physician Assistant 4082082557 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
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)

417 State St
Suite 330
Bangor, ME 04401-6638
Phone (207) 973-8881

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

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA2450MEMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Eastern Maine Medical Center CurrentSince Nov 10, 2024 Accepting new patients

Locations

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

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": "1650412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699574400000",
    "number": "1457095010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1599",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021599",
            "telephone_number": "207-404-8200",
            "fax_number": "207-947-0435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 UNION ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013060",
            "telephone_number": "207-404-8100",
            "fax_number": "207-947-0435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUIOU",
        "first_name": "KATHERINE",
        "middle_name": "P",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-20",
        "last_updated": "2023-11-10",
        "certification_date": "2023-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA2450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "PELLETIER",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.