NPIMap

Individual provider Active NPI

Stephanie M Gray, PA

  • Physician Assistant
  • East Waterboro, ME
National Provider Identifier
1922440361
Registry record updated Jun 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA1416 Issued in ME
Practice address
10 Goodall Dr
East Waterboro, ME 04030-5214
Phone
(207) 490-7760
NPI assigned
Jul 26, 2013
Last updated
Jun 25, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1092 NH
Physician Assistant 363A00000X PA1416 ME Primary

Addresses

Primary practice location

10 Goodall Dr
East Waterboro, ME 04030-5214

Mailing address

10 Goodall Dr
East Waterboro, ME 04030-5214
Phone (207) 490-7760

Other identifiers 1

IdentifierTypeStateIssuer
3102665MedicaidNH

Other names 1

  • Stephanie M Witbrodt Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130913000295 ME Practitioner - Physician Assistant 9234373283 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

1 Medical Ctr Dr
Biddeford, ME 04005-9422
Phone (207) 282-4270

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 885-9905

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1092NHMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth CurrentSince Jun 1, 2019 Accepting new patients
Mainehealth CurrentSince Jun 1, 2019 Accepting new patients

Locations

10 Goodall Dr
East Waterboro, ME 04030
Phone (207) 290-7780

10 Goodall Dr
Ste 900
East Waterboro, ME 04030
Phone (207) 490-7505

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

Interoperability endpoints

  • Direct secure messaging: sgray257776@direct.mmc.mainehealth.org

Organizations & group practices 3

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 37

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1374796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561420800000",
    "number": "1922440361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 GOODALL DR",
            "city": "EAST WATERBORO",
            "state": "ME",
            "postal_code": "040305214",
            "telephone_number": "207-490-7760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 GOODALL DR",
            "city": "EAST WATERBORO",
            "state": "ME",
            "postal_code": "040305214",
            "telephone_number": "207-490-7760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "STEPHANIE",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-26",
        "last_updated": "2019-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "1092",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA1416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3102665",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "WITBRODT",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in East Waterboro, ME

Sources for this page

Verify at the official NPI Registry.