Individual provider Active NPI

Paul Ouellette, PA

  • Medical Physician Assistant
  • Bangor, ME
National Provider Identifier
1811931520
Registry record updated Feb 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA387 Issued in ME
Practice address
360 Broadway
Bangor, ME 04401-3979
Phone
(207) 907-3000
Fax
(207) 907-1921
NPI assigned
Jun 15, 2006
Last updated
Feb 3, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA387 ME Primary

Addresses

Primary practice location

360 Broadway
Bangor, ME 04401-3979

Mailing address

C/O St Marys Health System - Provider Enrollment
PO Box 7291
Lewiston, ME 04243-7291
Phone (207) 777-8560

Other practice location 1

32 Resort Way
Ellsworth Internal Medicine
Ellsworth, ME 04605-1717
Phone (207) 664-5480

Other identifiers 1

IdentifierTypeStateIssuer
281070099MedicaidME

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pouellette632584@direct-prd.goodhelpconnections.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
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
I20080703000383 ME Practitioner - Physician Assistant 8224100441 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Joseph HospitalGroup PAC ID 6406766336, 197 clinicians

Practice addresses (Care Compare)

360 Broadway
Bangor, ME 04401-3979

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.58 of 100Reported as apm
Quality
83.17
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Maine Coast Regional Health Facilities Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643846400000",
    "number": "1811931520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT",
            "address_2": "PO BOX 7291",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042437291",
            "telephone_number": "207-777-8560",
            "fax_number": "207-777-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 BROADWAY",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013979",
            "telephone_number": "207-907-3000",
            "fax_number": "207-907-1921"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "32 Resort Way",
            "address_2": "ELLSWORTH INTERNAL MEDICINE",
            "address_purpose": "LOCATION",
            "city": "Ellsworth",
            "state": "ME",
            "postal_code": "046051717",
            "country_code": "US",
            "telephone_number": "207-664-5480",
            "fax_number": "207-664-5490",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OUELLETTE",
        "first_name": "PAUL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ME",
            "license": "PA387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "281070099",
            "state": "ME"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pouellette632584@direct-prd.goodhelpconnections.org",
            "affiliation": "N",
            "address_1": "360 Broadway",
            "city": "Bangor",
            "state": "ME",
            "country_code": "US",
            "postal_code": "044013979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.