Mamadou Sadio Diallo, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R221648 Issued in MD

Practice address

504 Lewis St
Havre de Grace, MD 21078-3420

Phone

(443) 502-5311

NPI assigned

Apr 28, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MD, DC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Group practices

Optimize Medical GroupGroup PAC ID 0446512040, 31 clinicians

MD Family Care LLCGroup PAC ID 2769762954, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• MD Family Care LLC

  • Family Medicine Physician
  • Havre de Grace, MD
  • NPI 1316315088
  Medicare reassignment Care Compare group NPD
• Optimize Medical Group

  • Adult Health Nurse Practitioner
  • Pikesville, MD
  • NPI 1952818999

  DC

  Medicare reassignment Care Compare group NPD
• MD Immediate Care LLC

  • Urgent Care Clinic/Center
  • Havre de Grace, MD
  • NPI 1770824195
  Medicare reassignment NPD
• Post Acute Health Care Services LLC

  • Acute Care Nurse Practitioner
  • Pikesville, MD
  • NPI 1982423653
  NPD (past)

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

{
    "created_epoch": "1619568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1164005104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1344 TRALEE CIR",
            "city": "ABERDEEN",
            "state": "MD",
            "postal_code": "210012642",
            "telephone_number": "646-260-6327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 LEWIS ST",
            "city": "HAVRE DE GRACE",
            "state": "MD",
            "postal_code": "210783420",
            "telephone_number": "443-502-5311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIALLO",
        "first_name": "MAMADOU",
        "middle_name": "SADIO",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-28",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R221648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Carefusion",
            "affiliation": "N",
            "endpointDescription": "Practice office",
            "address_1": "1344 Tralee Cir",
            "city": "Aberdeen",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210012642",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Justin Michael Decker, LGSW
• Deep Sleep
• Eve Ferruggiaro Desai, DDS
• Suresh M Dhanjani, M.D.
• Dhow Business Group
• Diy Wellness, Discovering the Individual in You, LLC
• Diy Wellness, Discovering the Individual in You, LLC
• Rebecca Garin Dizon, D.D.S.
• Scott D Doherty, O.D.
• Daion Donaldson

• Family Nurse Practitioner in Havre de Grace, MD
• Providers in Havre de Grace, MD by specialty
• Family Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.