KELLY M NICHOLS (MD) – Obstetrics & Gynecology Physician, NPI 1629462627
Obstetrics & Gynecology Physician
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Profile Insights
NPPES metrics only — not quality of care.
214 OBSTETRICS/GYNECOLOGY in ME
Provider Addresses for KELLY M NICHOLS (MD)
887 CONGRESS ST STE 200
PORTLAND, ME 041023166
Phone: (207) 771-5549
Fax: (207) 771-7834
Type: Mailing
101 DUDLEY ST
PROVIDENCE, RI 029052401
Phone: (401) 274-1122
Type: Mailing
300 Professional Dr Ste 2A
Scarborough, ME 040748897
Phone: (207) 771-5549
Fax: (207) 771-7834
Type: Location
22 Bramhall St
Portland, ME 041023134
Phone: (207) 662-0111
Fax: (207) 662-6006
Type: Location
16 Fahy St Ste 108
Belfast, ME 049156029
Phone: (207) 505-4332
Fax: (207) 536-3201
Type: Location
3 Glen Cove Dr Ste 1
Rockport, ME 048564232
Phone: (207) 301-8900
Fax: (207) 301-5296
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: 2023-11-17
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20210730000006 | I | Obstetrics/Gynecology | MA | TBD |
| I20231117002182 | I | Obstetrics/Gynecology | 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.
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 |
|---|---|---|
| Physician Assistant | PA | |
| - | ME | |
| - | ME | |
| - | ME | |
| - | ME | |
| Family Practice, Hospice/Palliative Care | ME | |
| Pediatric Medicine, Endocrinology | MA | |
| - | ME | |
| Family Practice | ME | |
| Nurse Practitioner | ME |
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