NPIMap

Individual provider Active NPI

Mina Assadollahzadeh, DO

  • Family Medicine Physician
  • Lewiston, ME
National Provider Identifier
1487068698
Registry record updated Oct 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO2756 Issued in ME
Practice address
15 Mollison Way
Lewiston, ME 04240-5805
Phone
(207) 777-4440
Fax
(207) 783-6660
NPI assigned
Jun 16, 2014
Last updated
Oct 26, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DO2756 ME Primary

Addresses

Primary practice location

15 Mollison Way
Lewiston, ME 04240-5805

Mailing address

PO Box 1638
Albany, NY 12201-1638
Phone (207) 777-4111

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
I20171102001692 ME Practitioner - Family Practice 0941427231 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of New England, College of Osteo Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys Regional Medical CenterGroup PAC ID 0042107120, 192 clinicians

Practice addresses (Care Compare)

15 Mollison Way
Lewiston, ME 04240-5805
Phone (207) 777-4440

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.93 of 100Reported as apm
Quality
83.31
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary's Regional Medical Center CurrentSince Oct 19, 2017 Accepting new patients
St. Mary's Regional Medical Center CurrentSince Oct 19, 2017 Accepting new patients

Locations

15 Mollison Way
Lewiston, ME 04240
Phone (207) 777-4440

15 Mollison Way
Rm A
Lewiston, ME 04240
Phone (207) 777-4440

93 Campus Ave
Lewiston, ME 04240
Phone (207) 755-3715

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 38

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

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1402876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508976000000",
    "number": "1487068698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1638",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122011638",
            "telephone_number": "207-777-4111",
            "fax_number": "207-783-6660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 MOLLISON WAY",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042405805",
            "telephone_number": "207-777-4440",
            "fax_number": "207-783-6660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ASSADOLLAHZADEH",
        "first_name": "MINA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-16",
        "last_updated": "2017-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "DO2756",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, ME

Sources for this page

Verify at the official NPI Registry.