NPIMap

Individual provider Active NPI

Benjamin Jacob Scoll, M.D.

  • Urology Physician
  • Portland, ME
National Provider Identifier
1174762116
Registry record updated Dec 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
018411 Issued in ME
Practice address
195 Fore River Pkwy
Suite 310
Portland, ME 04102-2780
Phone
(207) 523-5901
Fax
(207) 523-5902
NPI assigned
Feb 16, 2009
Last updated
Dec 5, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 018411 ME Primary

Addresses

Primary practice location

195 Fore River Pkwy
Suite 310
Portland, ME 04102-2780

Mailing address

195 Fore River Pkwy
Suite 310
Portland, ME 04102-2780
Phone (207) 523-5901

Other identifiers 1

IdentifierTypeStateIssuer
1174762116MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100903000012 ME Practitioner - Urology 5799809364 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Temple University School of Medicine, 2004
Medicare assignment
May accept Medicare assignment
Group practices
Fore River Urology LLCGroup PAC ID 5799911566, 10 clinicians

Practice addresses (Care Compare)

21 Donald B Dean Dr
Suite 1
South Portland, ME 04106-3252
Phone (207) 518-6617

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
018411MEMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fore River Urology LLC Urology CurrentSince Oct 1, 2013 Accepting new patients
Central Maine Medical Center CurrentSince Apr 30, 2012 Accepting new patients
Mercy Hospital CurrentSince Jul 30, 2010 Accepting new patients
Mercy Hospital CurrentSince Jul 30, 2010 Accepting new patients
Mercy Hospital Current Accepting new patients
Central Maine Medical Center CurrentSince Apr 30, 2012 Accepting new patients

Locations

300 Main St
Lewiston, ME 04240
Phone (207) 795-2400

195 Fore River Pkwy
Ste 310
Portland, ME 04102
Phone (207) 523-5901

21 Donald B Dean Dr
#1
South Portland, ME 04106
Phone (207) 518-6617

40 Park Rd
Westbrook, ME 04092
Phone (207) 857-8174

Interoperability endpoints

  • Direct secure messaging: benjamin.scoll.1@7607.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/7607/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir-myrecord.cerner.com/r4/4517c430-03bf-4e32-b324-1387cc4e73f3/

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 45

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1234742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323043200000",
    "number": "1174762116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 FORE RIVER PKWY",
            "address_2": "SUITE 310",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022780",
            "telephone_number": "207-523-5901",
            "fax_number": "207-523-5902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 FORE RIVER PKWY",
            "address_2": "SUITE 310",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022780",
            "telephone_number": "207-523-5901",
            "fax_number": "207-523-5902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCOLL",
        "first_name": "BENJAMIN",
        "middle_name": "JACOB",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-16",
        "last_updated": "2011-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "ME",
            "license": "018411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174762116",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, ME

Sources for this page

Verify at the official NPI Registry.