Jaymie Fe Potenciano Panuncialman, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD20891 Issued in ME

Practice address

35 State Hospital Dr
Bangor, ME 04401-8816

Phone

(207) 561-3600

NPI assigned

Feb 18, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jaymie Fe Sernal Potenciano Former name

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Penobscot Valley Dermatology, P.a.

  • Specialist
  • Bangor, ME
  • NPI 1952536880
  Medicare reassignment NPD

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

{
    "created_epoch": "1297987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553212800000",
    "number": "1548567068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "381 MAIN ST",
            "city": "ORONO",
            "state": "ME",
            "postal_code": "044733446",
            "telephone_number": "207-942-0669",
            "fax_number": "207-947-3143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 STATE HOSPITAL DR",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044018816",
            "telephone_number": "207-561-3600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "381 Main St",
            "address_purpose": "LOCATION",
            "city": "Orono",
            "state": "ME",
            "postal_code": "044733446",
            "country_code": "US",
            "telephone_number": "207-942-0669",
            "fax_number": "207-947-3143",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PANUNCIALMAN",
        "first_name": "JAYMIE FE",
        "middle_name": "POTENCIANO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-18",
        "last_updated": "2019-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "ME",
            "license": "MD20891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAYMIE FE",
            "last_name": "POTENCIANO",
            "middle_name": "SERNAL",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Dermatology Physician in Bangor, ME
• Providers in Bangor, ME by specialty
• Dermatology Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.