Spectrum Radiology South – Diagnostic Radiology Physician, NPI 1669488011
Diagnostic Radiology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Spectrum Radiology South
482, Congress Street, Downtown, East End, Portland, Cumberland County, Maine, 04101, United States
PORTLAND, ME 041013493
Phone:
Type: Mailing
Maine Medical Center, 22, Bramhall Street, West End, Portland, Cumberland County, Maine, 04102, United States
PORTLAND, ME 041023134
Phone: (207) 662-2571
Type: Location
PO BOX 95000 LB#7810
PHILADELPHIA, PA 191950001
Phone: (844) 947-4259
Fax: (302) 261-8368
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: 2025-12-31
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-09-30 (620 days ago).
Enrollment records
19
Earliest due date
2024-09-30
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 |
|---|---|---|---|---|
| O20040423000305 | O | Clinic/Group Practice | ME | TBD |
| O20090825000103 | O | Clinic/Group Practice | MA | 2026-10-31 |
| O20130328000256 | O | Clinic/Group Practice | NV | TBD |
| O20131011000231 | O | Clinic/Group Practice | CO | TBD |
| O20131127001392 | O | Clinic/Group Practice | IN | TBD |
| O20140303000978 | O | Clinic/Group Practice | OH | TBD |
| O20150429002397 | O | Clinic/Group Practice | TN | TBD |
| O20160913000589 | O | Clinic/Group Practice | KY | TBD |
| O20190919000111 | O | Clinic/Group Practice | NC | 2024-09-30 |
| O20200504001618 | O | Clinic/Group Practice | NY | TBD |
| O20200511000902 | O | Clinic/Group Practice | MI | TBD |
| O20200514000149 | O | Clinic/Group Practice | PA | TBD |
| O20201022001738 | O | Clinic/Group Practice | FL | 2026-07-31 |
| O20201210002946 | O | Clinic/Group Practice | MD | 2026-02-28 |
| O20220421002016 | O | Clinic/Group Practice | MO | TBD |
| O20230220000855 | O | Clinic/Group Practice | TX | TBD |
| O20230317002548 | O | Clinic/Group Practice | GA | TBD |
| O20230403000696 | O | Clinic/Group Practice | IA | TBD |
| O20251231003654 | O | Clinic/Group Practice | MN | TBD |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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 04101)
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