NPIMap

Organization Active NPI

Watch Me Shine, Inc.

  • Early Intervention Provider Agency
  • Bangor, ME
National Provider Identifier
1811124662
Registry record updated Feb 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
License
609327 Issued in ME
Legal business name
WATCH ME SHINE, INC.
Practice address
28 Gilman Plaza
Bangor, ME 04401
Phone
(207) 990-0162
Fax
(207) 990-0163
NPI assigned
Jun 19, 2009
Last updated
Feb 13, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2015

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

Authorized official

Name
Mrs. Tiffany S. Petronis
Title
Executive Director
Phone
(207) 664-8132

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X 609327 ME Primary

Addresses

Primary practice location

28 Gilman Plaza
Bangor, ME 04401

Mailing address

122 Jillian Way
C/O Tiffany Petronis
Glenburn, ME 04401
Phone (207) 990-0162

Other identifiers 2

IdentifierTypeStateIssuer
4323532200OtherMEMAINECARE FSD
432418200OtherMEMAINECARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181109000181 ME Part B Supplier - Clinic/Group Practice 2466706536 Receives reassigned benefits from 1 practitioner
Practice locations: Bangor, ME

National Provider Directory

National Provider Directory

Locations

28 Gilman Plz
Bangor, ME 04401
Phone (207) 990-0162

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1245369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423785600000",
    "number": "1811124662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 JILLIAN WAY",
            "address_2": "C/O TIFFANY PETRONIS",
            "city": "GLENBURN",
            "state": "ME",
            "postal_code": "04401",
            "telephone_number": "207-990-0162",
            "fax_number": "207-990-0163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 GILMAN PLAZA",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "04401",
            "telephone_number": "207-990-0162",
            "fax_number": "207-990-0163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATCH ME SHINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-19",
        "last_updated": "2015-02-13",
        "status": "A",
        "authorized_official_last_name": "PETRONIS",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "207-664-8132",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "ME",
            "license": "609327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAINECARE FSD",
            "identifier": "4323532200",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAINECARE",
            "identifier": "432418200",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.