NPIMap

Individual provider Active NPI

Timothy Kelly, PA-C

  • Physician Assistant
  • Lewiston, ME
National Provider Identifier
1750353710
Registry record updated Jan 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-815 Issued in ME
Practice address
300 Main St
Lewiston, ME 04240-7007
Phone
(207) 795-2641
Fax
(207) 753-7201
NPI assigned
Feb 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2026

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 PA-815 ME Primary

Addresses

Primary practice location

300 Main St
Lewiston, ME 04240-7007

Mailing address

300 Main St
Lewiston, ME 04240-7027
Phone (207) 795-2641

Other practice location 1

10 Gove Street
Boston, ME 02132
Phone (617) 569-5800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME, MA2 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
I20080614000049 ME Practitioner - Physician Assistant 4880765130 Reassigns benefits to 5 organizations
I20260206001822 MA Practitioner - Physician Assistant 4880765130 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Internal Medical Associates-EbnhcGroup PAC ID 6103814371, 239 clinicians

Practice addresses (Care Compare)

10 Gove St
East Boston, MA 02128-1920
Phone (617) 569-5800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.02 of 100Reported as group
Quality
59.99
Promoting interoperability
99
Improvement activities
40
Cost
74.25

Merit-based Incentive Payment System (MIPS)

Final score
75.94 of 100Reported as group
Quality
47.72
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA-815MEMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Central Maine Medical Center CurrentSince Jul 7, 2003 Accepting new patients
Mercy Hospital CurrentSince Jul 11, 2015 Accepting new patients
Central Maine Medical Center CurrentSince Jul 7, 2003 Accepting new patients
Rumford Hospital CurrentSince Jan 7, 2017 Accepting new patients
Mercy Hospital CurrentSince Jul 11, 2015 Accepting new patients
Neighborhealth Corporation Current Accepting new patients
Internal Medical Associates-Ebnhc CurrentSince Feb 2, 2026 Accepting new patients
Bridgton Hospital CurrentSince Jan 7, 2017 Accepting new patients
Bluewater Emergency Partners of Calais, LLC Dba: Bluewater Urgent Care Past Accepting new patients

Locations

10 Grove St
East Boston, MA 02128
Phone (617) 569-5800

10 Hospital Dr
Bridgton, ME 04009
Phone (207) 647-6000

300 Main St
Lewiston, ME 04240
Phone (207) 795-2400

420 Franklin St
Rumford, ME 04276
Phone (207) 364-4581

40 Park Rd
Westbrook, ME 04092
Phone (207) 857-8174

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/4517c430-03bf-4e32-b324-1387cc4e73f3/

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 1

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": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768953600000",
    "number": "1750353710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 MAIN ST",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042407027",
            "telephone_number": "207-795-2641",
            "fax_number": "207-753-7201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MAIN ST",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042407007",
            "telephone_number": "207-795-2641",
            "fax_number": "207-753-7201"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Gove Street",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "ME",
            "postal_code": "02132",
            "country_code": "US",
            "telephone_number": "617-569-5800",
            "fax_number": "617-568-4756",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "TIMOTHY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-03",
        "last_updated": "2026-01-21",
        "certification_date": "2026-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA-815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, ME

Sources for this page

Verify at the official NPI Registry.