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BLACK DOG MEDICAL PA
NPI 1154784668
Internal Medicine in Lamoine, ME

Active since April 01, 2016
11 MADISON AVENUE, LAMOINE, ME 04605(207) 200-1464(207) 805-8421 Get Directions Write a Review

NPPES record last updated: April 1, 2016. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Black Dog Medical Pa NPPES

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

BLACK DOG MEDICAL PA (NPI 1154784668) is a healthcare organization registered as an internal medicine in Lamoine, Maine and active in the NPI registry since April 2016. The organization lists Patricia Wyshak, Owner, as its authorized official.

NPPES Registry Identity

NPI1154784668
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameBLACK DOG MEDICAL PA
Location Address11 MADISON AVENUELamoine, ME 04605
Mailing Address11 Madison AvenueLamoine, ME 04605 · (207) 200-1464 · Fax (207) 805-8421
Phone(207) 200-1464
Fax(207) 805-8421
Organization SubpartNo
Authorized OfficialPatricia WyshakOwner · (207) 200-1464
Enumeration DateApril 1, 2016
✔ NPI 1154784668 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in ME · MD14569
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
11 MADISON AVENUE, Lamoine, ME 04605
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Black Dog Medical Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Black Dog Medical PA, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Patricia Wyshak, MD
Internal Medicine
NPI 1043254758
11 MADISON AVE
Lamoine, ME 04605
(207) 200-1464
✔ PECOS✔ Accepts Medicare0.1 mi
Kathleen Mccall, M.D.
Family Practice
NPI 1013995372
37 CLINIC RD
Gouldsboro, ME 04607
(207) 963-4066
✔ PECOS✔ Accepts Medicare11 mi

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

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 Black Dog Medical PA's NPI number?

The NPI number for Black Dog Medical PA is 1154784668. It was assigned to this organization in the NPPES registry on April 1, 2016.

Where is Black Dog Medical PA located?

Black Dog Medical PA is located at 11 Madison Avenue, Lamoine, ME 04605. The listed phone number is (207) 200-1464.

What is Black Dog Medical PA's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Black Dog Medical PA enrolled in Medicare?

Yes. Black Dog Medical PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Black Dog Medical PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Black Dog Medical PA, in Family Practice and Internal Medicine. A 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 the clinician's services. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Black Dog Medical PA accept?

Health plans from Anthem Blue Cross and Blue Shield list Black Dog Medical PA 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 Black Dog Medical PA was last updated on April 1, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.