Individual provider Active NPI

Basiru Samba

  • Case Manager/Care Coordinator
  • Bowie, MD
National Provider Identifier
1548636269
Registry record updated Aug 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Practice address
4802 Willes Vision Dr
Bowie, MD 20720-4671
Phone
(301) 284-0636
Fax
(301) 542-0184
NPI assigned
Aug 17, 2015
Last updated
Aug 17, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2015

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

Specialties & licenses 14

Specialty (taxonomy)CodeLicenseStatePrimary
Other Technician 247200000X NU
Chore Provider 372500000X NU
Adult Companion 372600000X NU
Attendant Care Provider 3747A0650X NU
Home Health Aide 374U00000X NU
Nursing Home Administrator 376G00000X NU
Homemaker 376J00000X NU
Nurse's Aide 376K00000X NU
Registered Nurse 163W00000X R159377 MD
Administrator Registered Nurse 163WA2000X R155931 MD
Licensed Practical Nurse 164W00000X LP34564 MD
Specialist 174400000X NU
Health Information Specialist/Technologist 246Y00000X NU
Case Manager/Care Coordinator 171M00000X NU Primary

Addresses

Primary practice location

4802 Willes Vision Dr
Bowie, MD 20720-4671

Mailing address

4802 Willes Vision Dr
Bowie, MD 20720-4671
Phone (301) 284-0636

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
R159377MDMDRegistered Nurse
R155931MDMDAdministrator Registered Nurse
LP34564MDMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
N3O Homecare, LLC Current Accepting new patients
N3O Homecare, LLC Current Accepting new patients
Royal Home Care LLC Current Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1439769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439769600000",
    "number": "1548636269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4802 WILLES VISION DR",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207204671",
            "telephone_number": "301-284-0636",
            "fax_number": "301-542-0184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4802 WILLES VISION DR",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207204671",
            "telephone_number": "301-284-0636",
            "fax_number": "301-542-0184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMBA",
        "first_name": "BASIRU",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-17",
        "last_updated": "2015-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "372500000X",
            "taxonomy_group": "",
            "desc": "Chore Provider",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3747A0650X",
            "taxonomy_group": "",
            "desc": "Technician, Attendant Care Provider",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "376G00000X",
            "taxonomy_group": "",
            "desc": "Nursing Home Administrator",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MD",
            "license": "R159377",
            "primary": false
        },
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "MD",
            "license": "R155931",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MD",
            "license": "LP34564",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "246Y00000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Health Information",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.