NPIMap

Organization Active NPI

E. Merle Bragdon, PHD, PA

  • Clinical Psychologist
  • Portland, ME
National Provider Identifier
1598069312
Registry record updated Jan 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS742 Issued in ME
Legal business name
E. MERLE BRAGDON, PHD, PA
Practice address
178 Middle St
Suite 300
Portland, ME 04101-4075
Phone
(207) 772-1570
Fax
(207) 772-2670
NPI assigned
Jan 9, 2011
Last updated
Jan 9, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2011

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

Authorized official

Name
E Merle Bragdon, PHD
Title
Owner
Phone
(207) 772-1570

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X PS742 ME Primary
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X PS1124 ME

Addresses

Primary practice location

178 Middle St
Suite 300
Portland, ME 04101-4075

Mailing address

178 Middle St
Suite 300
Portland, ME 04101-4075
Phone (207) 772-1570

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110323000368 ME Part B Supplier - Clinic/Group Practice 3678756012 Receives reassigned benefits from 2 practitioners
Practice locations: Brunswick, ME; Phippsburg, ME

National Provider Directory

National Provider Directory

Locations

8 Cumberland St
Brunswick, ME 04011
Phone (207) 218-0060

178 Middle St
Ste 300
Portland, ME 04101
Phone (207) 772-1164

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1294531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294531200000",
    "number": "1598069312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 MIDDLE ST",
            "address_2": "SUITE 300",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041014075",
            "telephone_number": "207-772-1570",
            "fax_number": "207-772-2670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "178 MIDDLE ST",
            "address_2": "SUITE 300",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041014075",
            "telephone_number": "207-772-1570",
            "fax_number": "207-772-2670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "E. MERLE BRAGDON, PHD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-09",
        "last_updated": "2011-01-09",
        "status": "A",
        "authorized_official_last_name": "BRAGDON",
        "authorized_official_first_name": "E MERLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-772-1570",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "ME",
            "license": "PS742",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "ME",
            "license": "PS1124",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.