Active NPI
Jacob Omar Khoussine, MD, PHD
- Ophthalmology Physician
- Portland, ME
National Provider Identifier
1063354280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- EC261086
- Practice address
- 22 Bramhall St
Portland, ME 04102-3175 - Phone
- (207) 662-7068
- NPI assigned
- Apr 7, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | EC261086 | ME | Primary |
Addresses
Primary practice location
22 Bramhall St
Portland, ME 04102-3175
Mailing address
4620 Frey St Apt 115
Madison, WI 53705-2903
Phone (405) 808-6005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| EC261086 | ME | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1775520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1775520000000",
"number": "1063354280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4620 FREY ST APT 115",
"city": "MADISON",
"state": "WI",
"postal_code": "537052903",
"telephone_number": "405-808-6005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 BRAMHALL ST",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041023175",
"telephone_number": "207-662-7068"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHOUSSINE",
"first_name": "JACOB",
"middle_name": "OMAR",
"credential": "MD, PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-04-07",
"last_updated": "2026-04-07",
"certification_date": "2026-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "ME",
"license": "EC261086",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.