NPIMap

Organization Active NPI

Endeavour Healthcare LLC

Doing business as Endeavour Healthcare

  • Internal Medicine Physician
  • Towson, MD
National Provider Identifier
1104555127
Registry record updated Sep 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ENDEAVOUR HEALTHCARE LLC
Doing business as
Endeavour Healthcare
Practice address
913 Southerly Road
264
Towson, MD 21204-2629
Phone
(443) 275-9164
Fax
(702) 977-7016
NPI assigned
Jun 6, 2022
Last updated
Sep 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dev Basu, MDNPI 1821386228
Title
Sole Member Owner
Phone
(443) 275-9164

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

913 Southerly Road
264
Towson, MD 21204-2629

Mailing address

913 Southerly Road
264
Towson, MD 21204-2629
Phone (443) 275-9164

Other names 1

  • Endeavour Healthcare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230410002370 MD Part B Supplier - Clinic/Group Practice 3072988815 Receives reassigned benefits from 9 practitioners
7 other NPIs on this enrollment
Practice locations: Aberdeen, MD; Towson, MD; Rising Sun, MD; Pikesville, MD; Middle River, MD; Havre de Grace, MD; Elkton, MD; Forest Hill, MD…

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726185600000",
    "number": "1104555127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "913 SOUTHERLY ROAD",
            "address_2": "264",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212042629",
            "telephone_number": "443-275-9164",
            "fax_number": "702-977-7016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "913 SOUTHERLY ROAD",
            "address_2": "264",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212042629",
            "telephone_number": "443-275-9164",
            "fax_number": "702-977-7016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENDEAVOUR HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-06",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A",
        "authorized_official_last_name": "BASU",
        "authorized_official_first_name": "DEV",
        "authorized_official_title_or_position": "SOLE MEMBER OWNER",
        "authorized_official_telephone_number": "443-275-9164",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Endeavour Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Endeavour Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Towson, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.