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DR. PAUL ANTHONY FALLON M.D
NPI 1093889206
Psychiatry & Neurology - Psychiatry in Portsmouth, NH

Active since November 20, 2006PECOS EnrolledAccepts Medicare Assignment
75/100
CMS Quality Rating
1145 SAGAMORE AVE, PORTSMOUTH, NH 03801(603) 431-6703(603) 430-3753 Get Directions Write a Review

NPPES record last updated: July 11, 2007. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Dr. Paul Anthony Fallon M.d NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. PAUL ANTHONY FALLON M.D (NPI 1093889206) is an individual psychiatry provider in Portsmouth, New Hampshire, licensed in New Hampshire (5612N) and active in the NPI registry since November 2006. He is enrolled in Medicare PECOS and is a graduate of Harvard Medical School (1974).

NPPES Registry Identity

NPI1093889206
Entity TypeIndividualMale
Primary Taxonomy2084P0800X
Provider Legal NameDR. PAUL ANTHONY FALLONCredential: M.D
Location Address1145 SAGAMORE AVEPortsmouth, NH 03801-5585
Mailing Address1145 Sagamore AvePortsmouth, NH 03801-5585 · (603) 431-6703 · Fax (603) 430-3753
Phone(603) 431-6703
Fax(603) 430-3753
Sole ProprietorNo
Medical School CMSHarvard Medical SchoolGraduated 1974
Enumeration DateNovember 20, 2006
Last NPPES UpdateJuly 11, 2007
✔ NPI 1093889206 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · PsychiatryAllopathic & Osteopathic Physicians
Taxonomy Code2084P0800X
License✔ Licensed in NH · 5612N
Definition
A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.
1145 SAGAMORE AVE, Portsmouth, NH 03801
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Other Identifiers 3

Other7706655Y0NH01NH · Bhn
Medicaid99003227NH
Medicare ID-Type UnspecifiedNH3227NH

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from NH Healthy Families, Anthem Blue Cross and Blue Shield, Taro Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Paul Anthony Fallon M.d is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5890857361
PECOS Enrollment IDI20081217000122
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Paul Fallon reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Seacoast Mental Health Center, Inc.
0.1 mi
Mental Health (Including Community Mental Health Center)
1145 SAGAMORE AVE
Portsmouth, NH 03801
  • Reassigned Medicare billing, New Hampshire enrollment
  • 65 clinicians in this Medicare group
NPI 1013092857 (603) 431-6703
Northeast Behavioral Health Corporation
35 mi
Mental Health (Including Community Mental Health Center)
800 CUMMINGS CENTER, SUITE 266T
Beverly, MA 01915
  • Reassigned Medicare billing, Massachusetts enrollment
  • 98 clinicians in this Medicare group
NPI 1154302586 (978) 921-1190

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 9

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Psychotherapy, 45 minutes 90834
Psychotherapy is a treatment method where you converse with a therapist about your thoughts, feelings, and behaviors. In a 45-minute session, the therapist assists you in understanding and managing your mental health concerns, improving emotional wellness, and promoting personal growth.
170 services53 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
165 services48 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
154 services62 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
103 services50 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
103 services48 patients
Telephone medical discussion with physician, 11-20 minutes 99442
This is a service where you have a phone conversation with your doctor for 11-20 minutes. It's used for discussing health concerns, reviewing test results, or managing ongoing conditions. It's a convenient way to receive medical advice without an in-person visit.
79 services37 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 03801 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$174.26 typical visit price
range $57.75 – $174.26
Typical copayment $43.56 (range $14.43 – $43.56)
Most-billed visit code 99205
Established Patient
$71.85 typical visit price
range $18.70 – $142.15
Typical copayment $17.96 (range $4.67 – $35.53)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

75/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HEATH GRAY
Counselor (Mental Health)
1145 SAGAMORE AVE
PORTSMOUTH, NH 03801
Rockingham County (603) 431-6703
MR. PHILIP GIBSON
Social Worker (Clinical)
1145 SAGAMORE AVE
PORTSMOUTH, NH 03801
Rockingham County (603) 431-6703
RACHEL GARDNER
Counselor
1145 SAGAMORE AVE
PORTSMOUTH, NH 03801
Rockingham County (603) 431-6703
ABIGAIL GERBINO
Counselor
1145 SAGAMORE AVE
PORTSMOUTH, NH 03801
Rockingham County (603) 431-6703
JULIANA DEFEO
Counselor
1145 SAGAMORE AVE
PORTSMOUTH, NH 03801
Rockingham County (603) 431-6703
SEACOAST MENTAL HEALTH CENTER, INC.
Clinic/Center (Mental Health (Including Community Mental Health Center))
1145 SAGAMORE AVE
PORTSMOUTH, NH 03801
Rockingham County (603) 431-6703
KRISTY MICHAUD
Case Manager/Care Coordinator
1145 SAGAMORE AVE
PORTSMOUTH, NH 03801
Rockingham County (603) 431-6703
MARIA BICK LICSW
Social Worker (Clinical)
1145 SAGAMORE AVE
PORTSMOUTH, NH 03801
Rockingham County (603) 431-6703

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Paul Fallon's NPI number?

The NPI number for Paul Fallon is 1093889206. It was assigned to this individual provider in the NPPES registry on November 20, 2006.

Where is Paul Fallon located?

Paul Fallon practices at 1145 Sagamore Ave, Portsmouth, NH 03801. The listed phone number is (603) 431-6703.

What is Paul Fallon's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.

Is Paul Fallon enrolled in Medicare?

Yes. Paul Fallon is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Paul Fallon's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Paul Fallon reassigns Medicare benefits to 2 organizations: Seacoast Mental Health Center, Inc. (Portsmouth, NH) and Northeast Behavioral Health Corporation (Beverly, MA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Paul Fallon's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Paul Fallon accept?

Health plans from Ambetter from NH Healthy Families, Anthem Blue Cross and Blue Shield and Taro Health list Paul Fallon as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Paul Fallon was last updated on July 11, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.