Individual provider Active NPI

Samuel Matthias Pettit, DO

  • Geriatric Medicine (Internal Medicine) Physician
  • Portland, ME
National Provider Identifier
1003556291
Registry record updated Aug 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
DO4340 Issued in ME
Practice address
66 Bramhall St
Portland, ME 04102-3344
Phone
(207) 662-3157
Fax
(207) 662-6434
NPI assigned
Mar 29, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X DO4340 ME Primary
Internal Medicine Physician 207R00000X DO4340 ME

Addresses

Primary practice location

66 Bramhall St
Portland, ME 04102-3344

Mailing address

66 Bramhall St
Portland, ME 04102-3344
Phone (207) 662-3157

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220913003271 ME Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 8123403045

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

NPI Registry JSON

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

{
    "created_epoch": "1648512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787011200000",
    "number": "1003556291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 BRAMHALL ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023344",
            "telephone_number": "207-662-3157",
            "fax_number": "207-662-6434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 BRAMHALL ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023344",
            "telephone_number": "207-662-3157",
            "fax_number": "207-662-6434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTIT",
        "first_name": "SAMUEL",
        "middle_name": "MATTHIAS",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-29",
        "last_updated": "2026-08-18",
        "certification_date": "2026-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "ME",
            "license": "DO4340",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ME",
            "license": "DO4340",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.