Mary Iaculli, D.O.

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

DO2695 Issued in ME

Practice address

331 Veranda St
Portland, ME 04103-5545

Phone

(207) 828-2402

NPI assigned

May 7, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Specialty

Sports Medicine

Education

University of New England, College of Osteo Medicine, 2014

Medicare assignment

May accept Medicare assignment

Group practices

Martin'S Point Health Care, Inc.Group PAC ID 5991776635, 91 clinicians

Riverview Physical Therapy Limited PartnershipGroup PAC ID 2769393586, shared by 2 NPIs, 58 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

86.47 of 100Reported as group

Quality

76.4

Promoting interoperability

100

Improvement activities

40

Cost

73.95

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/5857/brand/1/csg/1/fhir/r4
• Direct secure messaging: miaculli7900@direct.neighborhealth.masshiway.net
• Direct secure messaging: mary.iaculli.1@5857.direct.athenahealth.com

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

• Martin'S Point Health Care, Inc.

  • Family Medicine Physician
  • Portland, ME
  • NPI 1366474611

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Medical Associates of Ebnhc

  • Community Health Clinic/Center
  • East Boston, MA
  • NPI 1255451597
  NPD

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

{
    "created_epoch": "1399420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601596800000",
    "number": "1407266778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9746",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041045040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 VERANDA ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041035545",
            "telephone_number": "207-828-2402"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Boston Medical Ctr Pl",
            "address_2": "Boston Medical Center",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021182908",
            "country_code": "US",
            "telephone_number": "585-738-4986",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15 E Chestnut St",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "ME",
            "postal_code": "043305736",
            "country_code": "US",
            "telephone_number": "207-623-6663",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "77 Bates St Ste 201",
            "address_purpose": "LOCATION",
            "city": "Lewiston",
            "state": "ME",
            "postal_code": "042407637",
            "country_code": "US",
            "telephone_number": "207-795-8465",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IACULLI",
        "first_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-07",
        "last_updated": "2020-10-02",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": "ME",
            "license": "DO2695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mary.iaculli.1@5857.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "331 Veranda St",
            "city": "Portland",
            "state": "ME",
            "country_code": "US",
            "postal_code": "041035545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lisa J Hutter, RD
• Anne Huyler, M.D.
• Casey Huynh
• Stephanie Hayden Hyde, MS
• Cynthia Jo Hyman, MA CCCA
• Ibis Health Services-Maine LLC
• Sarah Ibrahim, DO
• Peter A Igneri, PA-C, MMSC
• Kayli Igoe
• Vanessa Marie Ilias, AGACNP-BC, APRN

• Sports Medicine (Family Medicine) Physician in Portland, ME
• Providers in Portland, ME by specialty
• Sports Medicine (Family Medicine) Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.