Active NPI
Nikola Charleen Radlach-Barnack, PA-C
- Physician Assistant
- South Portland, ME
National Provider Identifier
1598460099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 100 Gannett Dr Ste B
South Portland, ME 04106-5900 - Phone
- (207) 401-4353
- NPI assigned
- Apr 3, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary | ||
| Emergency Medical Services (Emergency Medicine) Physician | 207PE0004X | 202740 | ID |
Addresses
Primary practice location
100 Gannett Dr Ste B
South Portland, ME 04106-5900
Mailing address
100 Gannett Dr Ste B
South Portland, ME 04106-5900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 202740 | ID | MD | Emergency Medical Services (Emergency Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1680480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782691200000",
"number": "1598460099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 GANNETT DR STE B",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041065900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 GANNETT DR STE B",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041065900",
"telephone_number": "207-401-4353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RADLACH-BARNACK",
"first_name": "NIKOLA",
"middle_name": "CHARLEEN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-04-03",
"last_updated": "2026-06-29",
"certification_date": "2026-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
},
{
"code": "207PE0004X",
"taxonomy_group": "",
"desc": "Emergency Medicine, Emergency Medical Services",
"state": "ID",
"license": "202740",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.