DR. MARY IACULLI (D.O.) – Sports Medicine (Family Medicine) Physician, NPI 1407266778
Sports Medicine (Family Medicine) Physician
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Profile Insights
NPPES metrics only — not quality of care.
49 SPORTS MEDICINE in ME
Provider Addresses for DR. MARY IACULLI (D.O.)
331 VERANDA ST
PORTLAND, ME 041035545
Phone: (207) 828-2402
Type: Location
1 Boston Medical Ctr Pl
Boston Medical Center
Boston, MA 021182908
Phone: (585) 738-4986
Type: Location
15 E Chestnut St
Augusta, ME 043305736
Phone: (207) 623-6663
Type: Location
77 Bates St Ste 201
Lewiston, ME 042407637
Phone: (207) 795-8465
Type: Location
PO BOX 9746
PORTLAND, ME 041045040
Phone:
Type: Mailing
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: 2018-10-01
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 |
|---|---|---|---|---|
| I20181001001613 | I | Sports Medicine | ME | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 187 | 103 | $0 |
| 20611 | Aspiration and/or injection of fluid large joint using ultrasound guidance | 90 | 49 | $0 |
| J1040 | Injection, methylprednisolone acetate, 80 mg | 69 | 43 | $0 |
| J1030 | Injection, methylprednisolone acetate, 40 mg | 45 | 34 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 39 | 39 | $0 |
Insurance plans in this area (ZIP 04103)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | MI | |
| Family Practice | ME | |
| Nurse Practitioner | ME | |
| - | ME | |
| - | ME | |
| Family Practice | ME | |
| - | ME | |
| Physician Assistant | ME | |
| Family Practice | ME | |
| Family Practice | ME |
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