Basil E Fomanka, in Riverdale, MD - Medicare Nurse Practitioner

Basil E Fomanka, is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Riverdale, Maryland. His current practice location is 6200 Baltimore Ave Ste 300, Riverdale, Maryland. You can reach out to his office (for appointments etc.) via phone at (443) 520-8138.

Basil E Fomanka is licensed to practice in Maryland (license number R198010) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1013621010.

Contact Information

	Basil E Fomanka,
	6200 Baltimore Ave Ste 300, Riverdale, MD 20737-1054
	(443) 520-8138
	Not Available

Map and Direction

Provider's Profile

Full Name	Basil E Fomanka
Gender	Male
Speciality	Nurse Practitioner - Psychiatric/mental Health
Location	6200 Baltimore Ave Ste 300, Riverdale, Maryland
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1013621010
Provider Enumeration Date: 01/13/2023
Last Update Date: 08/18/2025

Medicare PECOS Information:

PECOS PAC ID: 6103364054
Enrollment ID: I20240809004008

Medical Identifiers

Medical identifiers for Basil E Fomanka such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1013621010	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LP0808X	Nurse Practitioner - Psychiatric/mental Health	R198010 (Maryland)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Basil E Fomanka allows following entities to bill medicare on his behalf.

Entity Name	Gebaj Mental Health And Core Services Clinic, Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1922866011 PECOS PAC ID: 5294273140 Enrollment ID: O20240809003997

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Basil E Fomanka is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Basil E Fomanka, 6200 Baltimore Ave Ste 300, Riverdale, MD 20737-1054 Ph: (443) 520-8138	Basil E Fomanka, 6200 Baltimore Ave Ste 300, Riverdale, MD 20737-1054 Ph: (443) 520-8138

Reviews and Comments

Nurse Practitioner Nurses in Riverdale, MD

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Miss Imelda Tividad Russell, CRNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 6510 Kenilworth Ave Ste 2500, Riverdale, MD 20737 Phone: 410-997-1907
Bosede M Adeleye, PMHNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 6801 Kenilworth Ave Ste 300-s2, Riverdale, MD 20737 Phone: 301-512-9449 Fax: 301-798-6260

Basil E Fomanka, - Medicare Nurse Practitioner in Riverdale, MD