Justin Otis, MD

Primary specialty

Behavioral Neurology & Neuropsychiatry PhysicianTaxonomy code 2084B0040X

License

MD26700 Issued in ME

Practice address

268 Stillwater Ave
Bangor, ME 04401-3945

Phone

(207) 973-6100

NPI assigned

Jun 20, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Enrolled in WI, ME2 enrollments

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 2

Specialty

Psychiatry

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Acadia Hospital Corp.Group PAC ID 7719878495, 88 clinicians

Eastern Maine Medical CenterGroup PAC ID 2062315161, 659 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northern Light Eastern Maine Medical Center Hospital, Bangor, ME, CCN 200033
• Northern Light Maine Coast Hospital Hospital, Ellsworth, ME, CCN 200050
• Northern Light a R Gould Hospital Hospital, Presque Isle, ME, CCN 200018
• Mount Desert Island Hospital Hospital, Bar Harbor, ME, CCN 201304

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jotis305477@direct.gundersenhealth.org

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.

• Acadia Hospital Corp

  • Psychiatric Hospital
  • Bangor, ME
  • NPI 1215940523
  Medicare reassignment Care Compare group NPD
• Eastern Maine Medical Center

  • General Acute Care Hospital
  • Bangor, ME
  • NPI 1790789147
  Medicare reassignment Care Compare group NPD
• Mainegeneral Medical Center

  • General Acute Care Hospital
  • Augusta, ME
  • NPI 1669423380
  Medicare reassignment NPD
• Gundersen Lutheran Medical Center Inc

  • Clinic/Center
  • La Crosse, WI
  • NPI 1225873458
  Medicare reassignment NPD
• Charles a Dean Memorial Hospital

  • Critical Access Hospital
  • Greenville, ME
  • NPI 1659388213
  Medicare reassignment
• Maine Coast Regional Health Facilities

  • General Acute Care Hospital
  • Ellsworth, ME
  • NPI 1740249739
  Medicare reassignment
• MRH Corp.

  • Critical Access Hospital
  • Dover Foxcroft, ME
  • NPI 1558319103
  Medicare reassignment
• Sebasticook Valley Health

  • Critical Access Hospital
  • Pittsfield, ME
  • NPI 1457461477
  Medicare reassignment
• The Aroostook Medical Center

  • General Acute Care Hospital
  • Presque Isle, ME
  • NPI 1396858999
  Medicare reassignment
• The Blue Hill Memorial Hospital

  • Critical Access Hospital
  • Blue Hill, ME
  • NPI 1023057809
  Medicare reassignment
• Gundersen Clinic LTD

  • Clinic/Center
  • La Crosse, WI
  • NPI 1851343115
  Medicare reassignment
• Eastern Maine Medical Center

  • Rehabilitation Hospital Unit
  • Bangor, ME
  • NPI 1780674689
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Eastern Maine Medical Center

  • General Acute Care Hospital
  • Bangor, ME
  • NPI 1790789147
  Care Compare affiliation
• Maine Coast Regional Health Facilities

  • General Acute Care Hospital
  • Ellsworth, ME
  • NPI 1740249739
  Care Compare affiliation
• Mount Desert Island Hospital

  • Dental Clinic/Center
  • Southwest Harbor, ME
  • NPI 1235553413

  Hospital

  Care Compare affiliation
• Mount Desert Island Hospital

  • Critical Access Hospital
  • Bar Harbor, ME
  • NPI 1790764512
  Care Compare affiliation
• The Aroostook Medical Center

  • General Acute Care Hospital
  • Presque Isle, ME
  • NPI 1396858999
  Care Compare affiliation

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

{
    "created_epoch": "1403222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677196800000",
    "number": "1962817619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "268 STILLWATER AVE",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013945",
            "telephone_number": "207-973-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "268 STILLWATER AVE",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013945",
            "telephone_number": "207-973-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTIS",
        "first_name": "JUSTIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-20",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084B0040X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": "IA",
            "license": "MD-48057",
            "primary": false
        },
        {
            "code": "2084B0040X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": "CO",
            "license": "CDRH.0060526",
            "primary": false
        },
        {
            "code": "2084B0040X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": "WI",
            "license": "404-320",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WI",
            "license": "404",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WI",
            "license": "404-320",
            "primary": false
        },
        {
            "code": "2084B0040X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": "ME",
            "license": "MD26700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pius Amoateng Osei-Bagyina, MD, MPH
• Kevin A Osgood, MD
• Chad Osmars, PHARMD
• Susan G Ostertag, MD
• Sheryl Lyn Ostrow, LCSW
• Wade Joel Otruba, M.D.
• Autumn Lee Otto, PA-C
• Cory Ouellette, DPT
• Diane F Ouellette, PMHNP
• Jonathan D Ouellette, PTA

• Behavioral Neurology & Neuropsychiatry Physician in Bangor, ME
• Providers in Bangor, ME by specialty
• Behavioral Neurology & Neuropsychiatry Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2023; 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.