KENNETH J BANASIAK (MD) – Pediatric Critical Care Medicine Physician, NPI 1205818929
Pediatric Critical Care Medicine Physician
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NPPES metrics only — not quality of care.
90 CRITICAL CARE (INTENSIVISTS) in ME
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Provider Addresses for KENNETH J BANASIAK (MD)
Maine Medical Center, 22, Bramhall Street, West End, Portland, Cumberland County, Maine, 04102, United States
PEDIATRIC INTENSIVE CARE
PORTLAND, ME 04102
Phone: (207) 662-2179
Fax: (207) 662-6326
Type: Location
301, Route 1, Cumberland County, Maine, 04074, United States
BUILDING C
SCARBOROUGH, ME 040747609
Phone: (207) 396-8600
Fax: (207) 396-8632
Type: Mailing
22 Bramhall St
Pediatric Intensive Care
Portland, ME 04102
Phone: (207) 662-2179
Fax: (207) 662-6326
Type: Location
282 WASHINGTON ST
HARTFORD, CT 061063322
Phone: (860) 545-9850
Fax: (860) 545-8812
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-01-10
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20050110000784 | I | Critical Care (Intensivists) | CT | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 04102)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Pediatric Medicine | NY | |
| - | CT | |
| Nurse Practitioner | CT | |
| - | CT | |
| Pediatric Medicine | CT | |
| - | MA | |
| Physician Assistant | CT | |
| - | MA | |
| - | CT | |
| - | MA |
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