Unknown Individual – Neurological Surgery Physician, NPI 1063456523
Neurological Surgery Physician
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Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
195, Fore River Parkway, Libbytown, Portland, Cumberland County, Maine, 04102, United States
SUITE 490
PORTLAND, ME 041022780
Phone: (207) 553-6054
Fax: (207) 553-6076
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99205 | New patient office or other outpatient visit, 60-74 minutes | 17 | 17 | $0 |
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 11 | 11 | $0 |
Insurance plans in this area (ZIP 04102)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| NEUROSURGERY | ME | 63048 | Partial removal of spine bone with release of spinal cord and/or nerves | 77 | 40 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| G A S T R O E N T E R O L O G Y | MA | |
| - | ME | |
| H O S P I T A L I S T | ME | |
| - | VT | |
| - | ME | |
| Nurse Practitioner | PA | |
| - | ME | |
| Family Practice | ME | |
| - | ME | |
| Nurse Practitioner | NY |
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