Individual provider Active NPI

Emily Medeiros

  • Physician Assistant
  • Dover, NH
National Provider Identifier
1699123398
Registry record updated Sep 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1178 Issued in NH
Practice address
19 Old Rollinsford Rd
Building B
Dover, NH 03820-2807
Phone
(603) 516-4265
NPI assigned
Jun 3, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1178 NH Primary

Addresses

Primary practice location

19 Old Rollinsford Rd
Building B
Dover, NH 03820-2807

Mailing address

789 Central Ave
Dover, NH 03820-2526
Phone (603) 516-4265

Other identifiers 1

IdentifierTypeStateIssuer
3105012MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160921001783 NH Practitioner - Physician Assistant 8123315082 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

19 Old Rollinsford Rd
BLDG B
Dover, NH 03820-2807
Phone (603) 516-4265

67 Corporate Dr
Portsmouth, NH 03801-2847

73 Corporate Dr
Portsmouth, NH 03801-2847
Phone (603) 610-8075

789 Central Ave
Dover, NH 03820-2526

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wentworth Douglass Physician Corporation CurrentSince Jul 19, 2016 Accepting new patients
Wentworth Douglass Hospital Current Accepting new patients
Westchester Neurological Consultant PC Past Accepting new patients

Locations

789 Central Ave
Dover, NH 03820
Phone (603) 740-2832

19 Old Rollinsford Rd
Bldg B
Dover, NH 03820
Phone (603) 516-4265

750 Central Ave
Ste Q
Dover, NH 03820
Phone (603) 742-6030

67 Corporate Dr
Bldg A
Portsmouth, NH 03801
Phone (603) 431-5529

3 Terrascape Pkwy
Somersworth, NH 03878
Phone (603) 609-6726

Interoperability endpoints

  • Direct secure messaging: medeiros.emily.wdh@direct.partners.masshiway.net
  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 4

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 2

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

NPI Registry JSON

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

{
    "created_epoch": "1464912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474588800000",
    "number": "1699123398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "789 CENTRAL AVE",
            "city": "DOVER",
            "state": "NH",
            "postal_code": "038202526",
            "telephone_number": "603-516-4265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 OLD ROLLINSFORD RD",
            "address_2": "BUILDING B",
            "city": "DOVER",
            "state": "NH",
            "postal_code": "038202807",
            "telephone_number": "603-516-4265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDEIROS",
        "first_name": "EMILY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-03",
        "last_updated": "2016-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "1178",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3105012",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dover, NH

Sources for this page

Verify at the official NPI Registry.