Individual provider Active NPI

Selamawit Addissie, MD

  • Internal Medicine Physician
  • Nottingham, MD
National Provider Identifier
1578201356
Registry record updated Jun 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0103751 Issued in MD
Practice address
4924 Campbell Blvd Ste 200
Nottingham, MD 21236-5914
Phone
(443) 442-2300
NPI assigned
May 23, 2022
Last updated
Jun 25, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Internal Medicine Physician 207R00000X D0103751 MD Primary

Addresses

Primary practice location

4924 Campbell Blvd Ste 200
Nottingham, MD 21236-5914

Mailing address

5200 Eastern Avenue
Mason F. Lord Building Center Tower, 3Rd Floor Room 342
Baltimore, MD 21224
Phone (410) 550-0526

Other practice location 1

5200 Eastern Avenue
Mason F. Lord Building Center Tower, 3rd Floor Room 342
Baltimore, MD 21224
Phone (410) 550-0526

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250729000986 MD Practitioner - Internal Medicine 8820476542 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Ohio State University College of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Agape Physical Therapy and Sports Rehabilitation LPGroup PAC ID 3870741390, 684 clinicians

Practice addresses (Care Compare)

1000 E Eager St
E Baltimore Med Ctr
Baltimore, MD 21202-5533
Phone (410) 522-9800

12 Newport Dr
Suite a
Forest Hill, MD 21050-1758

4924 Campbell Blvd
Suite 200
Baltimore, MD 21236-5914
Phone (443) 442-2300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0103751MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Johns Hopkins Community Physicians Internal Medicine CurrentSince Jul 1, 2025 Accepting new patients
Johns Hopkins Community Physicians CurrentSince Jul 1, 2025 Accepting new patients
Johns Hopkins Community Physicians, Inc Internal Medicine Current Accepting new patients

Locations

1000 E Eager St
Baltimore, MD 21202
Phone (410) 522-9800

6201 Greenleigh Ave
Middle River, MD 21220
Phone (410) 933-2704

4924 Campbell Blvd
Ste 200
Nottingham, MD 21236
Phone (443) 442-2300

Interoperability endpoints

  • Direct secure messaging: saddissie977928@direct.hopkinsmedicine.org

Organizations & group practices 4

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 4

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": "1653264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750809600000",
    "number": "1578201356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 EASTERN AVENUE",
            "address_2": "MASON F. LORD BUILDING CENTER TOWER, 3RD FLOOR ROOM 342",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21224",
            "telephone_number": "410-550-0526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4924 CAMPBELL BLVD STE 200",
            "city": "NOTTINGHAM",
            "state": "MD",
            "postal_code": "212365914",
            "telephone_number": "443-442-2300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5200 Eastern Avenue",
            "address_2": "Mason F. Lord Building Center Tower, 3rd Floor Room 342",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "21224",
            "country_code": "US",
            "telephone_number": "410-550-0526",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADDISSIE",
        "first_name": "SELAMAWIT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-23",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0103751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nottingham, MD

Sources for this page

Verify at the official NPI Registry.