NPIMap

Individual provider Active NPI

Samuel Emerson Hazard, PA-C

  • Physician Assistant
  • Portland, ME
National Provider Identifier
1619315819
Registry record updated Jan 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA376 Issued in ME
Practice address
22 Bramhall St RM 2218
Portland, ME 04102-3134
Phone
(207) 662-5610
NPI assigned
Jun 10, 2013
Last updated
Jan 7, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 7, 2020

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 PA376 ME Primary
Medical Physician Assistant 363AM0700X MA

Addresses

Primary practice location

22 Bramhall St RM 2218
Portland, ME 04102-3134

Mailing address

22 Bramhall St RM 2218
Portland, ME 04102-3134

Other practice location 1

2014 Washington St
Newton, MA 02462-1607
Phone (617) 243-6000

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
I20200225001545 ME Practitioner - Physician Assistant 3274760319 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

1 Medical Ctr Dr
Biddeford, ME 04005-9422
Phone (207) 282-4270

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

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4805MAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Jan 13, 2020 Accepting new patients
Maine Medical Partners CurrentSince Jan 13, 2020 Accepting new patients
Maine Medical Partners CurrentSince Jan 13, 2020 Accepting new patients
Mainehealth CurrentSince Jan 13, 2020 Accepting new patients

Locations

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

22 Bramhall St
Rm 2218
Portland, ME 04102
Phone (207) 662-5610

100 Campus Dr
Unit 107
Scarborough, ME 04074
Phone (207) 396-7565

Interoperability endpoints

  • Direct secure messaging: shazard277838@direct.mmc.mainehealth.org

Organizations & group practices 5

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 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1370822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578355200000",
    "number": "1619315819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 BRAMHALL ST RM 2218",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 BRAMHALL ST RM 2218",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023134",
            "telephone_number": "207-662-5610"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2014 Washington St",
            "address_purpose": "LOCATION",
            "city": "Newton",
            "state": "MA",
            "postal_code": "024621607",
            "country_code": "US",
            "telephone_number": "617-243-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAZARD",
        "first_name": "SAMUEL",
        "middle_name": "EMERSON",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-10",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA376",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.