Christopher Pezzullo, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

1505 Issued in ME

Practice address

295 Forest Ave
2ND Floor
Portland, ME 04101-2018

Phone

(207) 772-5437

Fax

(207) 879-1537

NPI assigned

Dec 15, 2005

Last updated

Jun 24, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Androscoggin Home Health Services, Inc

  dba Andwell Health Partners

  • Community Based Hospice Care Agency
  • Lewiston, ME
  • NPI 1780631770

  Corporate Director

  CMS ownership
• Androscoggin Home Health Services, Inc.

  dba Andwell Health Partners

  • Home Health Agency
  • Lewiston, ME
  • NPI 1245232347

  Corporate Director

  CMS ownership

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.

• Mercy Hospital

  • General Acute Care Hospital
  • Portland, ME
  • NPI 1629078712
  Medicare reassignment NPD
• Mercy Hospital

  dba Northern Light Mercy Health Center

  • Rural Health Clinic/Center
  • Windham, ME
  • NPI 1396496378
  NPD
• University of New England

  dba University Healthcare

  • Family Medicine Physician
  • Biddeford, ME
  • NPI 1699752055

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466726400000",
    "number": "1417933060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "295 FOREST AVE",
            "address_2": "2ND FLOOR",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041012018",
            "telephone_number": "207-772-5437",
            "fax_number": "207-879-1537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 FOREST AVE",
            "address_2": "2ND FLOOR",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041012018",
            "telephone_number": "207-772-5437",
            "fax_number": "207-879-1537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEZZULLO",
        "first_name": "CHRISTOPHER",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2016-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ME",
            "license": "1505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "293660099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie Catherine Pettit-Lane, DPT
• Andrea Pettit, ATC
• Samuel Matthias Pettit, DO
• Christine Peura, LCPC-C
• George Peyser
• Roger T Pezzuti, M.D.
• Kristen Pfeifle, M.S
• Nicholas Pfenning, CADC
• Rachel Elise Pferdehirt, M.D.
• Rishi Phakey, DMD

• Pediatrics Physician in Portland, ME
• Providers in Portland, ME by specialty
• Pediatrics Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.