Mohammad Basil Amin, M.D
Individual provider Active NPI Internal Medicine Physician · Berlin, VT
NPI 1104881101 · NPPES record last updated May 28, 2025
Key facts
- NPI
- 1104881101
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 042.0014077 (VT)
- Practice address
- 142 Woodridge Rd
Berlin, VT 05602-9165 - Phone
- (802) 371-4700
- NPI assigned
- Apr 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY, VT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220825003657 | NY | Practitioner - Internal Medicine |
3375441108 | Reassigns benefits to 1 organization |
| I20241226002024 | VT | Practitioner - Internal Medicine | 3375441108 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042.0014077 | VT | MD | Internal Medicine Physician |
| ME0072588 | FL | MD | Addiction Medicine (Internal Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| River Hospital, Inc. | Current |
Accepting new patients | |
| Central Vermont Medical Center Inc | Internal Medicine | Current |
Accepting new patients |
| River Hospital, Inc. | Current |
Accepting new patients |
Locations
4 Fuller St
Alexandria Bay, NY 13607
Phone (315) 482-1277
142 Woodridge Rd
Berlin, VT 05602
Phone (802) 371-4700
130 Fisher Rd
#C
Berlin, VT 05602
Phone (802) 225-5400
Interoperability endpoints
- mamin593570@direct.uvmhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction Medicine (Internal Medicine) Physician | 207RA0401X | ME0072588 | FL | |
| Internal Medicine Physician | 207R00000X | 042.0014077 | VT | Yes |
Addresses
Primary practice location
142 Woodridge Rd
Berlin, VT 05602-9165
Mailing address
PO Box 2468
Palatka, FL 32177
Phone (386) 325-8482
Other practice location 1
205 Zeagler Dr.
Suite # 401-B
Palatka, FL 32177
Phone (386) 325-8482
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 261232100 | Medicaid | FL |
Other providers in Berlin, VT
- Elizabeth Afanasyev
- Aimee Nazebeh Ahari
- Michelle Alberghini
- Emily Josephine Alfano
- Grace Altebrando
- Arkos Vermont, LLC
- Arthur J Esswein
- Eric L Asnis
- Christopher John Aubin
- Maria C. Aveni
All providers in Berlin, VT · Internal Medicine Physician in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 28, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.