NPIMap

Organization Active NPI

Southern Maine Physical Therapy, PA

  • Specialist
  • South Portland, ME
National Provider Identifier
1154536472
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
SOUTHERN MAINE PHYSICAL THERAPY, PA
Practice address
449 Cottage Rd
South Portland, ME 04106-4924
Phone
(207) 799-9700
Fax
(207) 799-9706
NPI assigned
May 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mrs. Toni Blanchard
Title
Billing Specialist
Phone
(207) 854-1239

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X ME Primary

Addresses

Primary practice location

449 Cottage Rd
South Portland, ME 04106-4924

Mailing address

PO Box 310
Westbrook, ME 04098-0310
Phone (207) 854-1239

Other identifiers 3

IdentifierTypeStateIssuer
040910OtherMEANTHEM BCBS
MNT112OtherMEHARVARD PILGRIM
2433023OtherMEAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040825001237 ME Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3678547478 Receives reassigned benefits from 11 practitioners
1 other NPI on this enrollment
Practice locations: Biddeford, ME; South Portland, ME

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Southern Maine Physical Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1154536472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 310",
            "city": "WESTBROOK",
            "state": "ME",
            "postal_code": "040980310",
            "telephone_number": "207-854-1239",
            "fax_number": "207-854-1230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "449 COTTAGE RD",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041064924",
            "telephone_number": "207-799-9700",
            "fax_number": "207-799-9706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MAINE PHYSICAL THERAPY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BLANCHARD",
        "authorized_official_first_name": "TONI",
        "authorized_official_title_or_position": "BILLING SPECIALIST",
        "authorized_official_telephone_number": "207-854-1239",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "ME",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "040910",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "MNT112",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2433023",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Portland, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.