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  5. Rhode Island Neurosurgical Institute, Inc.

Rhode Island Neurosurgical Institute, Inc.

Company Details

Name: Rhode Island Neurosurgical Institute, Inc.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Activ
Date of Organization in Rhode Island: 23 Sep 2002 (22 years ago)
Identification Number: 000127168
ZIP code: 02905
County: Providence County
Principal Address: 118DUDLEY STREET, PROVIDENCE, RI, 02905, USA
Purpose: TO RENDER PROFESSIONAL SERVICES BY PERSONS AUTHORIZED TO PRACTICE MEDICINE IN THE STATE OF RHODE ISLAND
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1295718914 2005-11-28 2008-06-26 118 DUDLEY ST, PROVIDENCE, RI, 029052403, US 118 DUDLEY ST, PROVIDENCE, RI, 029052403, US

Contacts
Phone +1 401-273-4155
Fax 4012734115

Authorized person
Name PRAKASH SAMPATH
Role PHYSICIAN/OWNER
Phone 4012734155

Taxonomy
Taxonomy Code 207T00000X - Neurological Surgery Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number RI52047
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
RHODE ISLAND NEUROSURGICAL INSTITUTE DEFINED BENEFIT PLAN 2022 050527374 2023-12-14 RHODE ISLAND NEUROSURGICAL INSTITUTE 11
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
RHODE ISLAND NEUROSURGICAL INSTITUTE DEFINED BENEFIT PLAN 2022 050527374 2023-06-21 RHODE ISLAND NEUROSURGICAL INSTITUTE 11
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
RHODE ISLAND NEUROSURGICAL INSTITUTE 401(K) PROFIT SHARING PLAN 2022 050527374 2023-12-14 RHODE ISLAND NEUROSURGICAL INSTITUTE 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050527374
Plan administrator’s name RHODE ISLAND NEUROSURGICAL INSTITUTE
Plan administrator’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4012734155
RHODE ISLAND NEUROSURGICAL INSTITUTE 401(K) PROFIT SHARING PLAN 2022 050527374 2023-06-21 RHODE ISLAND NEUROSURGICAL INSTITUTE 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050527374
Plan administrator’s name RHODE ISLAND NEUROSURGICAL INSTITUTE
Plan administrator’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4012734155
RHODE ISLAND NEUROSURGICAL INSTITUTE DEFINED BENEFIT PLAN 2021 050527374 2022-06-16 RHODE ISLAND NEUROSURGICAL INSTITUTE 11
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
RHODE ISLAND NEUROSURGICAL INSTITUTE 401(K) PROFIT SHARING PLAN 2021 050527374 2022-06-16 RHODE ISLAND NEUROSURGICAL INSTITUTE 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050527374
Plan administrator’s name RHODE ISLAND NEUROSURGICAL INSTITUTE
Plan administrator’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4012734155
RHODE ISLAND NEUROSURGICAL INSTITUTE 401(K) PROFIT SHARING PLAN 2020 050527374 2021-10-12 RHODE ISLAND NEUROSURGICAL INSTITUTE 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050527374
Plan administrator’s name RHODE ISLAND NEUROSURGICAL INSTITUTE
Plan administrator’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4012734155
RHODE ISLAND NEUROSURGICAL INSTITUTE DEFINED BENEFIT PLAN 2020 050527374 2021-10-12 RHODE ISLAND NEUROSURGICAL INSTITUTE 11
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
RHODE ISLAND NEUROSURGICAL INSTITUTE DEFINED BENEFIT PLAN 2019 050527374 2020-10-05 RHODE ISLAND NEUROSURGICAL INSTITUTE 14
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
RHODE ISLAND NEUROSURGICAL INSTITUTE 401(K) PROFIT SHARING PLAN 2019 050527374 2020-10-05 RHODE ISLAND NEUROSURGICAL INSTITUTE 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050527374
Plan administrator’s name RHODE ISLAND NEUROSURGICAL INSTITUTE
Plan administrator’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4012734155
File https://efast2-filings-public.s3.amazonaws.com/prd/2019/10/11/20191011151400P030049947597001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050527374
Plan administrator’s name RHODE ISLAND NEUROSURGICAL INSTITUTE
Plan administrator’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4012734155
File https://efast2-filings-public.s3.amazonaws.com/prd/2019/09/26/20190926154952P040040730055001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s DBA name NSTITUTE
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
File https://efast2-filings-public.s3.amazonaws.com/prd/2018/09/21/20180921143435P040200927527001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s DBA name NSTITUTE
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
File https://efast2-filings-public.s3.amazonaws.com/prd/2018/09/21/20180921094958P030080344207001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050527374
Plan administrator’s name RHODE ISLAND NEUROSURGICAL INSTITUTE
Plan administrator’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4012734155
File https://efast2-filings-public.s3.amazonaws.com/prd/2017/09/21/20170921093459P030147358439001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s DBA name NSTITUTE
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
File https://efast2-filings-public.s3.amazonaws.com/prd/2017/08/28/20170828090823P030102892999001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050527374
Plan administrator’s name RHODE ISLAND NEUROSURGICAL INSTITUTE
Plan administrator’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4012734155
File https://efast2-filings-public.s3.amazonaws.com/prd/2016/09/23/20160923071819P030007350343001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s DBA name NSTITUTE
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
File https://efast2-filings-public.s3.amazonaws.com/prd/2016/09/23/20160923074352P030007982513001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050527374
Plan administrator’s name RHODE ISLAND NEUROSURGICAL INSTITUTE
Plan administrator’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4012734155
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/09/25/20150925080133P040014416807001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050527374
Plan administrator’s name RHODE ISLAND NEUROSURGICAL INSTITUTE
Plan administrator’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4012734155

Signature of
Role Plan administrator
Date 2015-09-25
Name of individual signing PRAKASH SAMPATH
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/09/25/20150925083341P030016095569001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s DBA name NSTITUTE
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2015-09-25
Name of individual signing PRAKASH SAMPATH
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/09/26/20140926131934P030001095577001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2013-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s DBA name NSTITUTE
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905

Signature of
Role Plan administrator
Date 2014-09-26
Name of individual signing PRAKASH SAMPATH
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/09/26/20140926131254P040019586487001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050527374
Plan administrator’s name RHODE ISLAND NEUROSURGICAL INSTITUTE
Plan administrator’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4012734155

Signature of
Role Plan administrator
Date 2014-09-26
Name of individual signing PRAKASH SAMPATH
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/10/11/20131011122301P030014508181001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050527374
Plan administrator’s name RHODE ISLAND NEUROSURGICAL INSTITUTE
Plan administrator’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4012734155

Signature of
Role Plan administrator
Date 2013-10-11
Name of individual signing PRAKASH SAMPATH
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/06/06/20120606144343P030001310839001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 4012734155
Plan sponsor’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905

Plan administrator’s name and address
Administrator’s EIN 050527374
Plan administrator’s name RHODE ISLAND NEUROSURGICAL INSTITUTE
Plan administrator’s address 118 DUDLEY STREET, PROVIDENCE, RI, 02905
Administrator’s telephone number 4012734155

Signature of
Role Plan administrator
Date 2012-06-06
Name of individual signing PRAKASH SAMPATH
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
PRAKASH SAMPATH Agent 118 DUDLEY STREET, PROVIDENCE, RI, 02905, USA

PRESIDENT

Name Role Address
PRAKASH SAMPATH PRESIDENT 118DUDLEY STREET PROVIDENCE, RI 02905 USA

Filings

Number Name File Date
202451877600 Annual Report 2024-04-22
202334884530 Annual Report 2023-05-01
202222191940 Annual Report 2022-08-16
202222195740 Annual Report 2022-08-16
202222189280 Reinstatement 2022-08-16
202199653720 Revocation Certificate For Failure to File the Annual Report for the Year 2021-07-29
202196812670 Revocation Notice For Failure to File An Annual Report 2021-05-19
202049720310 Statement of Change of Registered/Resident Agent 2020-08-25
202042346760 Revocation Notice For Failure to Maintain a Registered Agent 2020-06-17
202036573660 Agent Resigned 2020-03-19

Related by officers

PRAKASH SAMPATH

SIGMA REALTY LLC CARgenix, Inc. Magpie Neurosurgical Innovation fund I LLC

Related by address

No related companies by address

Date of last update: 09 Oct 2024

Sources: Rhode Island Department of State

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