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BASIL E FOMANKA
NPI 1013621010
Nurse Practitioner - Psychiatric/Mental Health in Riverdale, MD

Active since January 13, 2023PECOS EnrolledAccepts Medicare Assignment
6200 BALTIMORE AVE, 300-R9, RIVERDALE, MD 20737(443) 520-8138 Get Directions Write a Review

NPPES record last updated: September 18, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Sep 18, 2025, Sep 11, 2025, Jun 27, 2024 and 1 more (4 updates tracked since 2023).

About Basil E Fomanka NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BASIL E FOMANKA (NPI 1013621010) is an individual psychiatric/mental health provider in Riverdale, Maryland, licensed in Maryland (R198010) and active in the NPI registry since January 2023. He is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1013621010
Entity TypeIndividualMale
Primary Taxonomy363LP0808X
Provider Legal NameBASIL E FOMANKA
Location Address6200 BALTIMORE AVE, 300-R9Riverdale, MD 20737-1054
Mailing Address6200 Baltimore Ave Ste 300-r9Riverdale, MD 20737-1054 · (443) 520-8138
Phone(443) 520-8138
Sole ProprietorYes
Medical School CMSOtherGraduated 2022
Enumeration DateJanuary 13, 2023
Last NPPES UpdateSeptember 18, 20254 updates tracked since enumeration
NPPES CertifiedSeptember 18, 2025
✔ NPI 1013621010 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in MD · R198010
6200 BALTIMORE AVE, Riverdale, MD 20737
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Basil E Fomanka is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6103364054
PECOS Enrollment IDI20240809004008
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 20737 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$100.31 typical visit price
range $65.18 – $194.86
Typical copayment $25.07 (range $16.29 – $48.71)
Most-billed visit code 99203
Established Patient
$113.72 typical visit price
range $21.40 – $158.88
Typical copayment $28.43 (range $5.35 – $39.72)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. TILLMAN ROBERT SEASE JR. DDS
Dentist (General Practice)
6200 BALTIMORE AVE, SUITE 200
RIVERDALE, MD 20737
Prince George's County (301) 864-5200
DR. RAMIEN ROYA TAJICK DDS
Dentist (General Practice)
6200 BALTIMORE AVE, SUITE 200
RIVERDALE, MD 20737
Prince George's County (301) 864-5200
THE DENTAL GROUP BY SMILE LOFT
Dentist
6200 BALTIMORE AVE
RIVERDALE, MD 20737
Prince George's County (240) 956-4956
DR. KASHIA FIGUEROA
Dentist (General Practice)
6200 BALTIMORE AVE, SUITE 200
RIVERDALE, MD 20737
Prince George's County (301) 864-5200
DR. MARK J MCCLURE DDS
Dentist (General Practice)
6200 BALTIMORE AVE, SUITE 200
RIVERDALE, MD 20737
Prince George's County (301) 864-5200
MCCLURE, BLUMENFELD, DIGREGORIO, SEASE, P.A., T/A THE DENTAL GROUP
Dentist
6200 BALTIMORE AVE, SUITE 200
RIVERDALE, MD 20737
Prince George's County (301) 964-5759
M&M ABUNDANT LIFE URGENT CARE & MENTAL HEALTH CLINIC LLC
Nurse Practitioner (Family)
6200 BALTIMORE AVE
RIVERDALE, MD 20737
Prince George's County (786) 788-5080
DR. TERESA REGIL DDS
Dentist (Pediatric Dentistry)
6200 BALTIMORE AVE, SUITE 200
RIVERDALE, MD 20737
Prince George's County (301) 864-5200

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Basil Fomanka's NPI number?

The NPI number for Basil Fomanka is 1013621010. It was assigned to this individual provider in the NPPES registry on January 13, 2023.

Where is Basil Fomanka located?

Basil Fomanka practices at 6200 Baltimore Ave 300-R9, Riverdale, MD 20737. The listed phone number is (443) 520-8138.

What is Basil Fomanka's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Basil Fomanka enrolled in Medicare?

Yes. Basil Fomanka is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Basil Fomanka was last updated on September 18, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.