NPIMap

Individual provider Active NPI

Basem Mohamed Elbrolosy, M.D.

  • Family Medicine Physician
  • Poland, ME
National Provider Identifier
1326211582
Registry record updated Sep 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD24059 Issued in ME
Practice address
1230 Maine St
Poland, ME 04274-7325
Phone
(207) 998-4483
Fax
(207) 998-2189
NPI assigned
Apr 9, 2008
Last updated
Sep 1, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2020

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 MD24059 ME Primary

Addresses

Primary practice location

1230 Maine St
Poland, ME 04274-7325

Mailing address

C/O St Marys Health System - Provider Enrollment
PO Box 7291
Lewiston, ME 04240-7291
Phone (207) 777-8950

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME, VA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20201006000891 ME Practitioner - Family Practice 3678908936 Reassigns benefits to 1 organization
I20240828000918 VA Practitioner - Family Practice 3678908936 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10 Stafford Lakes Pkwy
Suite 106
Stafford, VA 22406-7304
Phone (540) 370-0295

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mary Washington Healthcare Physicians Family Medicine CurrentSince Aug 26, 2024 Accepting new patients
St. Mary's Regional Medical Center CurrentSince Sep 21, 2020 Accepting new patients
Mary Washington Healthcare Physicians CurrentSince Aug 26, 2024 Accepting new patients
St. Mary's Regional Medical Center CurrentSince Sep 21, 2020 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

93 Campus Ave
Lewiston, ME 04240
Phone (207) 755-3715

1230 Maine St
Poland, ME 04274
Phone (207) 998-4483

10 Stafford Lakes Pkwy
Ste 106
Fredericksburg, VA 22406
Phone (540) 370-0295

1001 Sam Perry Blvd
Fredericksburg, VA 22401
Phone (540) 741-1100

Interoperability endpoints

  • Direct secure messaging: belbrolosy123312@marywashingtonhealthcare.direct-ci.com

Organizations & group practices 5

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

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": "1207699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598918400000",
    "number": "1326211582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT",
            "address_2": "PO BOX 7291",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042407291",
            "telephone_number": "207-777-8950",
            "fax_number": "207-777-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 MAINE ST",
            "city": "POLAND",
            "state": "ME",
            "postal_code": "042747325",
            "telephone_number": "207-998-4483",
            "fax_number": "207-998-2189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELBROLOSY",
        "first_name": "BASEM",
        "middle_name": "MOHAMED",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-09",
        "last_updated": "2020-09-01",
        "certification_date": "2020-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "MD24059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poland, ME

Sources for this page

Verify at the official NPI Registry.