Active NPI
Kenneth Maisak, DPM
- Foot & Ankle Surgery Podiatrist
- Portland, ME
National Provider Identifier
1710125596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot & Ankle Surgery Podiatrist
- License
- POD1077
- Practice address
- 68 Marginal Way
Portland, ME 04101-2444 - Phone
- (207) 879-1339
- Fax
- (207) 879-1092
- NPI assigned
- Feb 2, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | POD1077 | ME | Primary |
Addresses
Primary practice location
68 Marginal Way
Portland, ME 04101-2444
Mailing address
68 Marginal Way
Portland, ME 04101-2444
Phone (207) 879-1339
Medicare participation
Medicare enrollment files- 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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110727000752 | ME | Practitioner - Podiatry | 6800064361 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Podiatry
- Education
- California School of Podiatric Medicine, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Portland Foot and Ankle, PA
Practice addresses (Care Compare)
63 Marginal Way
Suite 300
Portland, ME 04101-1964
Phone (207) 879-1339
Hospital & facility affiliations
- Mainehealth Maine Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 20 |
| Removal of skin lesions | 67 |
| Removal of nail tissue | 251 |
| Removal or shaving of skin growth | 95 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| POD1077 | ME | MD | Foot & Ankle Surgery Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Portland Foot & Ankle, PA | Foot & Ankle Surgery | Current | Accepting new patients |
Locations
63 Marginal Way
Ste 300
Portland, ME 04101
Phone (207) 879-1339
68 Marginal Way
Portland, ME 04101
Phone (207) 879-1339
Organizations & group practices 1
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.
-
- Foot & Ankle Surgery Podiatrist
- Portland, ME
- NPI 1417952318
Foot & Ankle Surgery, ME
Hospital & facility affiliations 36
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233532800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346803200000",
"number": "1710125596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "68 MARGINAL WAY",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041012444",
"telephone_number": "207-879-1339",
"fax_number": "207-879-1092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "68 MARGINAL WAY",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041012444",
"telephone_number": "207-879-1339",
"fax_number": "207-879-1092"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAISAK",
"first_name": "KENNETH",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-02-02",
"last_updated": "2012-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "ME",
"license": "POD1077",
"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 Sep 5, 2012; 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.