Individual provider Active NPI

Michael C Mutchie, PA-C

  • Physician Assistant
  • Norway, ME
National Provider Identifier
1518745652
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2780 Issued in ME
Practice address
193 Main St
Norway, ME 04268-5645
Phone
(207) 828-2100
Fax
(207) 743-5026
NPI assigned
Sep 19, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X PA2780 ME Primary

Addresses

Primary practice location

193 Main St
Norway, ME 04268-5645

Mailing address

193 Main St
Norway, ME 04268-5645
Phone (207) 828-2100

Other practice location 1

9 Ansel Ln
North Yarmouth, ME 04097-6341
Phone (207) 331-9166

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
I20241115002797 ME Practitioner - Physician Assistant 4880128677 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

181 Main St
Norway, ME 04268-5664
Phone (207) 743-5933

193 Main St
Norway, ME 04268-5645

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

Hospital & facility affiliations

  • Mainehealth Stephens Hospital Hospital, Norway, ME, CCN 201315

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA2780MEMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Nov 7, 2024 Accepting new patients
Mainehealth CurrentSince Nov 7, 2024 Accepting new patients
Mainehealth Current Accepting new patients

Locations

193 Main St
Norway, ME 04268
Phone (207) 743-2544

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

Interoperability endpoints

  • Direct secure messaging: mmutchie884833@direct.mmc.mainehealth.org

Organizations & group practices 4

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": "1695081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734307200000",
    "number": "1518745652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "193 MAIN ST",
            "city": "NORWAY",
            "state": "ME",
            "postal_code": "042685645",
            "telephone_number": "207-828-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "193 MAIN ST",
            "city": "NORWAY",
            "state": "ME",
            "postal_code": "042685645",
            "telephone_number": "207-828-2100",
            "fax_number": "207-743-5026"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9 Ansel Ln",
            "address_purpose": "LOCATION",
            "city": "North Yarmouth",
            "state": "ME",
            "postal_code": "040976341",
            "country_code": "US",
            "telephone_number": "207-331-9166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUTCHIE",
        "first_name": "MICHAEL",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-19",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA2780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norway, ME

Sources for this page

Verify at the official NPI Registry.