MAMADOU SADIO DIALLO FNP
NPI 1164005104
Nurse Practitioner - Family in Havre De Grace, MD
About Mamadou Sadio Diallo Fnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MAMADOU SADIO DIALLO FNP (NPI 1164005104) is an individual family provider in Havre De Grace, Maryland, licensed in Maryland (R221648) and active in the NPI registry since April 2021. He is enrolled in Medicare PECOS and is a graduate of Other (2020).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mamadou Sadio Diallo Fnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
3Medicare enrollment records show Mamadou Diallo reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Havre De Grace, MD 21078
- Reassigned Medicare billing, Maryland enrollment
- 4 clinicians in this Medicare group
Havre De Grace, MD 21078
- Reassigned Medicare billing, Maryland enrollment
- 3 clinicians in this Medicare group
Pikesville, MD 21208
- Reassigned Medicare billing, District of Columbia and Maryland enrollments
- 59 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 3
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 21078 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 5
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
HAVRE DE GRACE, MD 21078
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 Mamadou Diallo's NPI number?
The NPI number for Mamadou Diallo is 1164005104. It was assigned to this individual provider in the NPPES registry on April 28, 2021.
Where is Mamadou Diallo located?
Mamadou Diallo practices at 504 Lewis St, Havre De Grace, MD 21078. The listed phone number is (443) 502-5311.
What is Mamadou Diallo's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Mamadou Diallo enrolled in Medicare?
Yes. Mamadou Diallo is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Mamadou Diallo's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mamadou Diallo reassigns Medicare benefits to 3 organizations: MD Immediate Care LLC (Havre De Grace, MD), MD Family Care LLC (Havre De Grace, MD) and Optimize Medical Group (Pikesville, MD). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mamadou Diallo's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Mamadou Diallo was last updated on April 28, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Mamadou Sadio Diallo, FNP · NPI 1164005104
Family physician in Havre De Grace, Maryland. Individual provider, active in the CMS NPPES registry since April 28, 2021.
## Identity
- **NPI:** 1164005104 (Entity type: Individual)
- **Enumerated:** April 28, 2021
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** R221648 (Maryland)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 504 LEWIS ST, Havre De Grace, MD 21078-3420
- **Phone:** (443) 502-5311
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 3 organizations under Medicare reassignment (form CMS-855R): MD Immediate Care LLC (NPI 1770824195, Havre De Grace, MD); MD Family Care LLC (NPI 1316315088, Havre De Grace, MD); Optimize Medical Group (NPI 1952818999, Pikesville, MD) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2020
## Record status
- **NPPES last updated:** April 28, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1164005104) · Data from the CMS NPPES public registry.