NPIMap

Individual provider Active NPI

Mariam Bukky Salisu, MD

  • Pain Medicine (Anesthesiology) Physician
  • Williamsport, PA
National Provider Identifier
1821484213
Registry record updated Jan 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
MD471881 Issued in PA
Practice address
1100 Grampian Blvd
Williamsport, PA 17701-1900
Phone
(570) 326-8457
Fax
(570) 326-7989
NPI assigned
Apr 13, 2015
Last updated
Jan 7, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 7, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 25MA11723900 NJ
Vascular Surgery Physician 2086S0129X 25MA11723900 NJ
Pain Medicine (Anesthesiology) Physician 207LP2900X MD471881 PA Primary

Addresses

Primary practice location

1100 Grampian Blvd
Williamsport, PA 17701-1900

Mailing address

1201 Grampian Blvd
Williamsport, PA 17701-1900
Phone (570) 326-8723

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ2 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
I20201012002575 PA Practitioner - Pain ManagementPractitioner - Anesthesiology 7618226689 Reassigns benefits to 2 organizations
I20241016004170 NJ Practitioner - Pain ManagementPractitioner - Anesthesiology 7618226689

Care Compare profile

Medicare Care Compare
Specialty
Pain ManagementAlso: Anesthesiology
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
Relevium Pain and Vein LLCGroup PAC ID 1355849365, 4 clinicians

Practice addresses (Care Compare)

2000 Westinghouse Dr
Cranberry Township, PA 16066-5238

296 E Brown St
Suite D MVM Health Pain Vein and Wellness
East Stroudsburg, PA 18301-3011
Phone (570) 445-2200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.06 of 100Reported as group
Quality
62.07
Promoting interoperability
100
Improvement activities
40
Cost
74.81

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA11723900NJMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Susquehanna Physician Services CurrentSince Nov 1, 2020 Accepting new patients
Forte Anesthesia Associates LLC Pain Medicine Current Accepting new patients
Susquehanna Physician Services CurrentSince Nov 1, 2020 Accepting new patients
Robbins Rehabilitation West, LLC CurrentSince Oct 10, 2025 Accepting new patients
Emmaus Surgical Center LLC Past Accepting new patients
Aether Medicine PLLC PastSince Apr 2, 2021 Accepting new patients

Locations

2045 Westgate Dr
Ste 303
Bethlehem, PA 18017

1100 Grampian Blvd
Williamsport, PA 17701
Phone (570) 326-8005

1100 Grampian Blvd
#P
Williamsport, PA 17701
Phone (570) 326-8457

1201 Grampian Blvd
Williamsport, PA 17701
Phone (570) 326-8723

700 High St
Williamsport, PA 17701
Phone (570) 321-1000

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22278/brand/1/csg/1/fhir/r4
  • Direct secure messaging: msalisu219698@upmc.direct-ci.com

Organizations & group practices 7

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 8

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": "1428883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736208000000",
    "number": "1821484213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 GRAMPIAN BLVD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011900",
            "telephone_number": "570-326-8723",
            "fax_number": "570-326-8922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 GRAMPIAN BLVD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011900",
            "telephone_number": "570-326-8457",
            "fax_number": "570-326-7989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALISU",
        "first_name": "MARIAM",
        "middle_name": "BUKKY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-13",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NJ",
            "license": "25MA11723900",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NJ",
            "license": "25MA11723900",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "PA",
            "license": "MD471881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsport, PA

Sources for this page

Verify at the official NPI Registry.