Jason Alexander Lange

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

CNP211177 Issued in ME

Practice address

43 Sokokis TRL
East Waterboro, ME 04030-5400

Phone

(207) 247-6742

Fax

(207) 247-6114

NPI assigned

Aug 9, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12090/brand/1/csg/1/fhir/r4
• Direct secure messaging: jason.lange.1@12090.direct.athenahealth.com

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.

• Waterboro Village Pediatrics LLC PA

  • Pediatrics Physician
  • East Waterboro, ME
  • NPI 1225018740
  NPD (past)

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

{
    "created_epoch": "1628467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1699449082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 AVON ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041012364",
            "telephone_number": "646-369-8785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 SOKOKIS TRL",
            "city": "EAST WATERBORO",
            "state": "ME",
            "postal_code": "040305400",
            "telephone_number": "207-247-6742",
            "fax_number": "207-247-6114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANGE",
        "first_name": "JASON",
        "middle_name": "ALEXANDER",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-09",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "202105402NP-PP",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ME",
            "license": "CNP211177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie M Gray, PA
• Lois Kathleen Grosvenor, MSW, LCSW
• Hannaford Bros Co LLC
• Heather L Kierstead-Dupuis, RN
• Grace Elizabeth Lacourse
• Katelyn Marie Pio Lovely, NP
• Mainehealth
• McGarrigle RX Consulting LLC
• Jessika T Morin, MD
• Nichole Charise Martin Reader, FNP

• All providers in East Waterboro, ME
• Family Nurse Practitioner in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.