Neil Anjan Basumallik, MD
Individual provider Active NPI Internal Medicine Physician · Salisbury, MD
NPI 1922636588 · NPPES record last updated Oct 19, 2023
Key facts
- NPI
- 1922636588
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- D0097335 (MD)
- Practice address
- 1639 Woodbrooke Dr
Salisbury, MD 21804-8502 - Phone
- (410) 543-7475
- NPI assigned
- Mar 30, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- State University of New York at Buffalo School of Medicine, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Tidalhealth Primary Care LLC
Practice addresses (Care Compare)
1639 Woodbrooke Dr
Salisbury, MD 21804-8502
Phone (410) 912-5785
400 Eastern Shore Dr
Salisbury, MD 21804-5513
Phone (410) 543-8240
Hospital & facility affiliations
- Tidalhealth Home Care
- Enhabit Home Health
- Coastal Hospice Inc
- Tidalhealth Peninsula Regional, Inc
- Tidalhealth Nanticoke, Inc.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231016000153 | MD | Practitioner - Internal Medicine | 6901251719 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0097335 | MD | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tidalhealth Primary Care, LLC | Current |
Accepting new patients |
Locations
1639 Woodbrooke Dr
Salisbury, MD 21804
Phone (410) 543-7475
400 Eastern Shore Dr
Salisbury, MD 21804
Phone (410) 543-2255
100 E Carroll St
Salisbury, MD 21801
Phone (410) 543-7100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Internal Medicine Physician | 207R00000X | D0097335 | MD | Yes |
Addresses
Primary practice location
1639 Woodbrooke Dr
Salisbury, MD 21804-8502
Mailing address
1639 Woodbrooke Dr
Salisbury, MD 21804-8502
Other practice location 1
Rutgers RWJMS, Department of Medicine
125 Paterson Street. CAB 7300
New Brunswick, NJ 08901
Phone (732) 235-8887
Other providers in Salisbury, MD
- Caitlin Barry
- John A Bartkovich
- Allison Barton
- Robert S Bartoshesky
- Jessica Bas
- James C Bauman
- Efigenio Leynes Bautista
- Bay Area Center for Independent Living, Inc.
- Bay Harbor Operator LLC
- Bay Shore Servcies, Inc.
All providers in Salisbury, MD · Internal Medicine Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.