NPIMap

Organization Active NPI

Southern Maine Physical Therapy

  • Physical Therapist
  • South Portland, ME
National Provider Identifier
1699875674
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SOUTHERN MAINE PHYSICAL THERAPY
Practice address
449 Cottage Rd
South Portland, ME 04106-4924
Phone
(207) 799-9700
Fax
(207) 799-9706
NPI assigned
Sep 22, 2006
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
Ms. Brenda Ayre, PT/OWNER
Title
Owner
Phone
(207) 799-9700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X ME Primary

Addresses

Primary practice location

449 Cottage Rd
South Portland, ME 04106-4924

Mailing address

449 Cottage Rd
South Portland, ME 04106-4924
Phone (207) 799-9700

Other identifiers 7

IdentifierTypeStateIssuer
2433023OtherMEAETNA GROUP NUMBER
040910OtherMEANTHEM GROUP NUMBER
100482300OtherMEDEPT OF LABOR WKERS COMP
130470100MedicaidME
DB3088OtherMEMEDICARE RAILROAD
MNT112OtherMEHARVARD PILGRIM
5182235OtherMECIGNA HEALTH CARE

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
This NPI is an additional NPI on the 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.

Locations

17 Lincoln St
Ste 016
Biddeford, ME 04005
Phone (207) 799-9700

449 Cottage Rd
South Portland, ME 04106
Phone (207) 799-9700

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1699875674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "AYRE",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-799-9700",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PT/OWNER"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "ME",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA GROUP NUMBER",
            "identifier": "2433023",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM GROUP NUMBER",
            "identifier": "040910",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR WKERS COMP",
            "identifier": "100482300",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130470100",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DB3088",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "MNT112",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HEALTH CARE",
            "identifier": "5182235",
            "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.