NPIMap

Individual provider Active NPI

Gordon Loughlin Hazen, PA

  • Physician Assistant
  • Portland, ME
National Provider Identifier
1689600298
Registry record updated Sep 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA2928 Issued in ME
Practice address
22 Bramhall St
Portland, ME 04102-3134
Phone
(207) 662-0111
NPI assigned
Jun 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2025

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 PA2928 ME Primary
Physician Assistant 363A00000X 004258 NY

Addresses

Primary practice location

22 Bramhall St
Portland, ME 04102-3134

Mailing address

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 662-0111

Other practice location 1

71 Prospect Ave
Suite L10
Hudson, NY 12534-2907
Phone (518) 697-3555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, ME2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190225002746 NC Practitioner - Physician Assistant 7911046362 Reassigns benefits to 2 organizations
I20260305003782 ME Practitioner - Physician Assistant 7911046362 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

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

Hospital & facility affiliations

  • Mainehealth Maine Medical Center Hospital, Portland, ME, CCN 200009

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA2928MEMDPhysician Assistant
004258NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
NHCS Physicians Inc CurrentSince Nov 13, 2019 Accepting new patients
NHCS Physicians, Inc. CurrentSince Nov 13, 2019 Accepting new patients
Mainehealth CurrentSince Jan 21, 2026 Accepting new patients
Mainehealth CurrentSince Jan 21, 2026 Accepting new patients
Dennis Marcus MD PC Past Accepting new patients
Columbia Memorial Hospital Past Accepting new patients

Locations

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

2460 Curtis Ellis Dr
Rocky Mount, NC 27804
Phone (252) 443-8199

Interoperability endpoints

  • Direct secure messaging: ghazen98742@albanymed.direct-ci.com

Organizations & group practices 8

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 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": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757030400000",
    "number": "1689600298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 BRAMHALL ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023134",
            "telephone_number": "207-662-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 BRAMHALL ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023134",
            "telephone_number": "207-662-0111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "71 Prospect Ave",
            "address_2": "Suite L10",
            "address_purpose": "LOCATION",
            "city": "Hudson",
            "state": "NY",
            "postal_code": "125342907",
            "country_code": "US",
            "telephone_number": "518-697-3555",
            "fax_number": "518-697-3558",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAZEN",
        "first_name": "GORDON",
        "middle_name": "LOUGHLIN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-24",
        "last_updated": "2025-09-05",
        "certification_date": "2025-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA2928",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "004258",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.