NPIMap

Organization Active NPI

Southern Maine Physical Medicine and Rehabilitation, PLLC

  • Sports Medicine (Neuromusculoskeletal Medicine) Physician
  • Portland, ME
National Provider Identifier
1487691879
Registry record updated Jul 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Neuromusculoskeletal Medicine) PhysicianTaxonomy code 204C00000X
License
1709 Issued in ME
Legal business name
SOUTHERN MAINE PHYSICAL MEDICINE AND REHABILITATION, PLLC
Practice address
335 Brighton Ave
Portland, ME 04102-2362
Phone
(207) 775-4000
NPI assigned
Jun 2, 2006
Last updated
Jul 21, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2008

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

Authorized official

Name
Dr. Elwood I Fox, D.O.
Title
President/Physician
Phone
(207) 893-2992

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Neuromusculoskeletal Medicine) Physician 204C00000X 1709 ME Primary

Addresses

Primary practice location

335 Brighton Ave
Portland, ME 04102-2362

Mailing address

PO Box 178
Gorham, ME 04038-0178
Phone (207) 893-2992

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216598400000",
    "number": "1487691879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 178",
            "city": "GORHAM",
            "state": "ME",
            "postal_code": "040380178",
            "telephone_number": "207-893-2992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 BRIGHTON AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022362",
            "telephone_number": "207-775-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MAINE PHYSICAL MEDICINE AND REHABILITATION, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2008-07-21",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "ELWOOD",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICIAN",
        "authorized_official_telephone_number": "207-893-2992",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "ME",
            "license": "1709",
            "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 Jul 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.