Angela L Branda, D.O.
Individual provider Active NPI Pediatrics Physician · Portland, ME
NPI 1710173133 · NPPES record last updated Nov 4, 2011
Key facts
- NPI
- 1710173133
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 2172 (ME)
- Practice address
- 295 Forest Ave
2R
Portland, ME 04101-2018 - Phone
- (207) 772-5437
- Fax
- (207) 879-1537
- NPI assigned
- Sep 19, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Pediatric Medicine
- Education
- Ohio University, College of Osteopathic Medicine, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Rocky Vista Health Center LLC
Practice addresses (Care Compare)
272 E Ctr St
Ivins, UT 84738-6456
Phone (435) 233-9500
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ME, UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110818000219 | ME | Practitioner - Pediatric Medicine | 6901075472 | Reassigns benefits to 1 organization |
| I20221109002077 | UT | Practitioner - Pediatric Medicine |
6901075472 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2172 | ME | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Be Well My Friend LLC | Current |
Accepting new patients |
Locations
12 Shuman Ave
Ste 6
Augusta, ME 04330
Phone (207) 307-0958
174 S Freeport Rd
Ste 2A
Freeport, ME 04032
Phone (207) 869-9010
Interoperability endpoints
- angela.branda.1@8078.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 2172 | ME | Yes |
Addresses
Primary practice location
295 Forest Ave
2R
Portland, ME 04101-2018
Mailing address
PO Box 2500
Lewiston, ME 04243-2500
Phone (207) 784-2554
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AA221173 | Other | ME | HPHC |
| 1710173133 | Medicaid | ME |
Other providers in Portland, ME
- Thomas B Brady
- E. Merle Bragdon
- Jennifer Woodbury Bragg
- Valerie Anne Bramble
- Jane F Branch
- Rachel L Brander
- Carolyn Branson
- Erica Brasley
- Charlotte A Brasseux
- Sarah Braun
All providers in Portland, ME · Pediatrics Physician in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.