NPIMap

Individual provider Active NPI

Brookellen Rider, DO

  • Family Medicine Physician
  • Berlin, MD
National Provider Identifier
1326036617
Registry record updated Aug 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
H0044828 Issued in MD
Practice address
314 Franklin Ave
Suite 403
Berlin, MD 21811
Phone
(410) 629-1995
Fax
(410) 629-1993
NPI assigned
Oct 11, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X H0044828 MD Primary

Addresses

Primary practice location

314 Franklin Ave
Suite 403
Berlin, MD 21811

Mailing address

PO Box 49
400 Eastern Shore Drive
Salisbury, MD 21804
Phone (410) 749-0821

Other identifiers 1

IdentifierTypeStateIssuer
483791600MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040603000443 MD Practitioner - Family Practice 6608858873 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Tidalhealth Primary Care LLCGroup PAC ID 7911320635, 63 clinicians
Fairway Physical Therapy LLCGroup PAC ID 3971563222, 85 clinicians

Practice addresses (Care Compare)

11101 Cathage Rd
Unit 102
Berlin, MD 21811-2115
Phone (410) 912-6104

400 Eastern Shore Dr
Salisbury, MD 21804-5513
Phone (410) 543-8240

7100 Fairway Dr
Suite 42
Palm Beach Gardens, FL 33418-3778
Phone (561) 775-7775

Hospital & facility affiliations

  • Homecall Home health agency, Easton, MD, CCN 217066
  • Tidalhealth Home Care Home health agency, Salisbury, MD, CCN 217079
  • Adoration Home Health Home health agency, Salisbury, MD, CCN 217111
  • Amedisys Home Health Home health agency, Georgetown, DE, CCN 087034
  • Enhabit Home Health Home health agency, Salisbury, MD, CCN 217157
  • Coastal Hospice Inc Hospice, Salisbury, MD, CCN 211505
  • Tidalhealth Peninsula Regional, Inc Hospital, Salisbury, MD, CCN 210019
  • Atlantic General Hospital Hospital, Berlin, MD, CCN 210061
  • Tidalhealth Nanticoke, Inc. Hospital, Seaford, DE, CCN 080006
  • Beebe Medical Center Hospital, Lewes, DE, CCN 080007

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
H0044828MDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tidalhealth Peninsula Regional, Inc. Family Medicine Current Accepting new patients
Tidalhealth Primary Care, LLC Family Medicine CurrentSince Sep 1, 2020 Accepting new patients
Delmarva Endoscopy Center LLC CurrentSince Jan 1, 2020 Accepting new patients
Tidalhealth Peninsula Regional, Inc. CurrentSince Jan 1, 2020 Accepting new patients
Little Doc Rider PC Family Medicine PastSince Jan 26, 2004 Accepting new patients
Atlantic General Hospital Corporation Family Medicine Past Accepting new patients
Atlantic Immedicare LLC Family Medicine Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

314 Franklin Ave
Ste 403
Berlin, MD 21811
Phone (410) 629-1995

11101 Cathage Rd
Unit 102
Berlin, MD 21811
Phone (410) 912-6104

1639 Woodbrooke Dr
Salisbury, MD 21804
Phone (410) 543-7475

145 E Carroll St
Salisbury, MD 21801
Phone (410) 546-6400

145 E Carroll St
Ste A
Salisbury, MD 21801

400 Eastern Shore Dr
Salisbury, MD 21804
Phone (410) 543-2255

106 Milford St
Ste 201
Salisbury, MD 21804
Phone (410) 543-1616

428 W Market St
Snow Hill, MD 21863
Phone (410) 632-0892

Organizations & group practices 9

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534464000000",
    "number": "1326036617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 49",
            "address_2": "400 EASTERN SHORE DRIVE",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "21804",
            "telephone_number": "410-749-0821",
            "fax_number": "410-219-5662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 FRANKLIN AVE",
            "address_2": "SUITE 403",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "21811",
            "telephone_number": "410-629-1995",
            "fax_number": "410-629-1993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDER",
        "first_name": "BROOKELLEN",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-10-11",
        "last_updated": "2018-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "H0044828",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "483791600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berlin, MD

Sources for this page

Verify at the official NPI Registry.