MS. TRACY M BENNETT (NPI# 1457560419) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457560419 |
| Entity Type | Individual |
| Full Name | MS. TRACY M BENNETT |
| Credential | P.A.-C |
| Practice Address |
360 Broadway Bangor ME 04401-3900 |
| Mailing Address |
C/ost Marys Health System - Provider Enrollment Po Box 7291 Lewiston ME 04243-7291 |
| Practice Telephone | 2079073650 |
| Practice Fax Number | 2079073660 |
| Mailing Telephone | 2077778560 |
| Mailing Fax Number | 2077778800 |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2019-11-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA1097 | ME | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285243444 | Tracy Travina Bennett | Registered Nurse | 10762 Wilson Ave, Alta Loma, CA 91737-2436 | 2020-07-23 |
| 1548741895 | Tracy Lynne Bennett | Nurse Practitioner | 6262 Highway 316 S, Marvell, AR 72366-9439 | 2018-08-24 |
| 1811379332 | Tracy Lynn Bennett | Nurse Practitioner | 3281 Kessock Ridge Trl, Snellville, GA 30039-3112 | 2015-06-20 |
| 1285790360 | Tracy S Bennett | Psychologist | 340 Rosewood Ave, Camarillo, CA 93010-5927 | 2006-12-31 |
| 1619449147 | Tracy Bennett | Social Worker | 12265 James St, Holland, MI 49424-8613 | 2018-12-21 |
| 1487869210 | Tracy W Bennett | Counselor | 95 India St, Portland, ME 04101-4250 | 2007-05-14 |
| Street Address |
360 BROADWAY |
| City | BANGOR |
| State | ME |
| Zip Code | 04401-3900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154321545 | St. Joseph Hospital | General Acute Care Hospital | 360 Broadway, Bangor, ME 04401-3979 | 2005-07-28 |
| 1346802170 | Sadie Austin | Physician Assistant | 360 Broadway, Bangor, ME 04401-3900 | 2019-07-02 |
| 1386202794 | Ashley Gott Haase | Physical Therapist | 360 Broadway, Bangor, ME 04401-3979 | 2019-05-31 |
| 1992286546 | Royce Blackwood | Physician Assistant | 360 Broadway, Bangor, ME 04401-3979 | 2018-08-22 |
| 1609356559 | Casey Marie Northup | Pharmacy Technician | 360 Broadway, Bangor, ME 04401-3900 | 2018-08-20 |
| 1407332869 | Sara Winings | Pharmacist | 360 Broadway, Bangor, ME 04401-3979 | 2018-07-18 |
| 1811489156 | Sandra Bartlett | Pharmacist | 360 Broadway, Bangor, ME 04401-3979 | 2018-06-02 |
| 1366999534 | Eliza Sharma | Internal Medicine | 360 Broadway, Bangor, ME 04401-3900 | 2016-09-06 |
| 1871946731 | Katelyn Hopper | Anesthesiology | 360 Broadway, Bangor, ME 04401-3979 | 2016-07-15 |
| 1790139459 | Stephen Calabrese | Anesthesiology | 360 Broadway, Bangor, ME 04401-3979 | 2016-04-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184222523 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 110 Longview Dr, Bangor, ME 04401 | 2020-10-16 |
| 1033737937 | Daniel John Phulman | Counselor | 202 Exchange Street, Bangor, ME 04401 | 2020-07-08 |
| 1770104358 | Elizabeth Sarah Caruson | Physician Assistant | 417 State Street Webber Medical Building, East St, Ste. 121, Bangor, ME 04401 | 2020-05-05 |
| 1053961300 | Erika Dean | Occupational Therapist | 84 Sylvan Rd., Bangor, ME 04401 | 2019-09-18 |
| 1942853635 | Wildworks Therapy, Pllc | Occupational Therapist | 123 Mt Hope Ave, Bangor, ME 04401 | 2019-07-22 |
| 1255999173 | Jessica Arbisi | Physician Assistant | 1 Northeast Drive, Bangor, ME 04401 | 2019-06-05 |
| 1699232041 | Ehab Khamis Elhefnawi | Anesthesiology | Emmc Anesthesia Professional Service, 489 State Street, Bangor, ME 04401 | 2019-02-21 |
| 1477028884 | Zvorufura Makura | Otolaryngology | 885 Union Street, Ste 145, Bangor, ME 04401 | 2018-10-11 |
| 1255826541 | Lindsey M Fields | Optometrist | 955 Broadway Eye Center Northeast Dba Northeast Eyecare, Bangor, ME 04401 | 2018-06-28 |
| 1992211338 | Debra J Mcintyre | Counselor | 157 Park Street, #5, Bangor, ME 04401 | 2017-12-21 |
| Find all providers in zip 04401 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770104358 | Elizabeth Sarah Caruson | Physician Assistant | 417 State Street Webber Medical Building, East St, Ste. 121, Bangor, ME 04401 | 2020-05-05 |
| 1932647112 | Cory Callahan | Physician Assistant | 417 State St, Suite 340, Bangor, ME 04401 | 2017-02-07 |
| 1437559010 | Shelby June Slauenwhite | Physician Assistant | 489 State St Ste 221, Bangor, ME 04401-6616 | 2014-09-02 |
| 1437242294 | Sunbury Primary Care, P.a. | Physician Assistant | 133 Corporate Drive, Suite 5, Bangor, ME 04401 | 2006-10-02 |
| 1891890166 | John F Cassidy Iv | Physician Assistant | 34 Summer St, Bangor, ME 04401-6446 | 2006-09-13 |
| 1831124338 | Isolde Kissinger | Physician Assistant | 520 Railroad St, Bangor, MI 49013-1490 | 2006-07-12 |
| 1366472847 | Michael Moreau | Physician Assistant | 417 State Street Webber West Suite 340, Bangor, ME 04401-6616 | 2006-07-03 |
| 1104868603 | Karen D Godin | Physician Assistant | 417 State St Ste 400, Penobscot Respiratory, Bangor, ME 04401-6096 | 2006-06-11 |
| 1912976911 | Joseph Harkins | Physician Assistant | 417 State St Ste 121, Bangor, ME 04401-6630 | 2006-03-14 |
| 1932194214 | Shirley E Sanders | Physician Assistant | 555 Railroad St, Bangor, MI 49013-1464 | 2005-09-13 |
| Find all providers in BANGOR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.