Samuel Sulaiman Koroma, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R219005 Issued in MD

Practice address

101 Paul Mellon CT Ste 5
Waldorf, MD 20602-2761

Phone

(301) 810-4026

NPI assigned

Jan 5, 2020

Last updated

Oct 5, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD, DC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Advance Integrated Health LLCGroup PAC ID 4183043623, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Advance Integrated Health, LLC

  • Multi-Specialty Clinic/Center
  • Bowie, MD
  • NPI 1952934671

  DC, Single Specialty

  Medicare reassignment Care Compare group NPD
• Umaru Labay-Kamara, MD, LLC

  dba Axios Behavioral Health

  • Psychiatry Physician
  • La Plata, MD
  • NPI 1790289890

  Single Specialty

  Medicare reassignment NPD
• Advance Integrated Health, LLC

  dba AIH Behavioral Health

  • Psychiatric/Mental Health Nurse Practitioner
  • Waldorf, MD
  • NPI 1952976771
  NPD Authorized official

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

{
    "created_epoch": "1578182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1790324960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 PAUL MELLON CT STE 5",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206022761",
            "telephone_number": "301-810-4026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 PAUL MELLON CT STE 5",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206022761",
            "telephone_number": "301-810-4026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOROMA",
        "first_name": "SAMUEL",
        "middle_name": "SULAIMAN",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-05",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R219005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Rose Knodell, AUD
• Knowing You, LLC
• Oluwakemisola Abiodun Koku
• Jodi Kollias, O.D.
• Yuen Ling Wong Kong, P.A-C
• Erik Korzen, D.C.
• KP Global Solutions LLC
• Gabriel Kresge, PT
• Elena Krestinicheva
• Krishan M Mathur MD (Cambridge Oncology and Infusion Center)

• Psychiatric/Mental Health Nurse Practitioner in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.