Nicholas Nicholson Borodulia, M.D.
Individual provider Active NPI Family Medicine Physician · Fenwick Island, DE
NPI 1225004294 · NPPES record last updated May 11, 2022
Key facts
- NPI
- 1225004294
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- D0028769 (MD)
- Practice address
- 1400 Coastal Hwy
Fenwick Island, DE 19944-4452 - Phone
- (302) 581-0458
- Fax
- (302) 581-0460
- NPI assigned
- Feb 28, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 9
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- George Washington University School of Medicine, 1978
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1 Meadow St
Berlin, MD 21811-1309
Phone (302) 581-0458
1323 Mount Hermon Rd
Suite 3a
Salisbury, MD 21804-5258
Phone (443) 944-9896
1400 Coastal Hwy
Fenwick Island, DE 19944-4452
Hospital & facility affiliations
- Adoration Home Health
- Homecall
- Enhabit Home Health
- Coastal Hospice Inc
- Tidalhealth Peninsula Regional, Inc
- Atlantic General Hospital
- Beebe Medical Center
- Berlin Nursing and Rehabilitation Center
- Autumn Lake Healthcare at Chesapeake Woods
Merit-based Incentive Payment System (MIPS)
- Final score
- 13.76 of 100
- Quality
- 0
- Improvement activities
- 0
- Cost
- 45.87
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MD, DE
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Autumn Lake Healthcare at Chesapeake Woods |
Skilled nursing facility | Operational/Managerial Control Adp of the SNF |
Apr 1, 2022 Apr 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061026000157 | MD | Practitioner - Family Practice | 6608873138 | Reassigns benefits to 3 organizations |
| I20061026000181 | DE | Practitioner - Family Practice |
6608873138 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C10001802 | DE | MD | Family Medicine Physician |
| D0028769 | MD | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Five Star Physician Services, LLC | Family Medicine | Current |
Accepting new patients |
| Fenwick Medical Center PA | Family Medicine | Current |
Accepting new patients |
| Atlantic Recovery, LLC | Family Medicine | Current |
Accepting new patients |
| Atlantic Recovery and Wellness | Family Medicine | Current | Accepting new patients |
| Atlantic Immedicare LLC | Family Medicine | Past | Accepting new patients |
| Berlin Health Care LLC | Past | Accepting new patients | |
| 525 Glenburn Opco LLC | Past |
Accepting new patients |
Locations
101 Delaware Ave
Delmar, DE 19940
Phone (302) 846-3077
1209 Coastal Hwy
Fenwick Island, DE 19944
Phone (302) 539-2399
1400 Coastal Hwy
Fenwick Isle, DE 19944
Phone (302) 581-0458
1 Meadow St
Berlin, MD 21811
Phone (302) 581-0458
785 Elkridge Landing Rd
Ste 300
Linthicum Heights, MD 21090
Phone (443) 323-3014
1323 Mount Hermon Rd
Ste 3A
Salisbury, MD 21804
Phone (410) 543-8844
205 S Division St
Salisbury, MD 21801
Phone (410) 543-0400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | C10001802 | DE | |
| Family Medicine Physician | 207Q00000X | D0028769 | MD | Yes |
Addresses
Primary practice location
1400 Coastal Hwy
Fenwick Island, DE 19944-4452
Mailing address
12036 S Piney Point Rd
Bishopville, MD 21813-1542
Phone (302) 581-0458
Other practice location 1
205 S Division St
Salisbury, MD 21801-4930
Phone (443) 944-9896
Other practice location 2
1400 Coastal Hwy
Fenwick Island, DE 19944-4452
Phone (443) 944-9896
Other providers in Fenwick Island, DE
All providers in Fenwick Island, DE · Family Medicine Physician in Delaware
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2022. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.