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Rhode Island Neurosurgical Institute, Inc.

Company Details

Name: Rhode Island Neurosurgical Institute, Inc.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Dissolved
Date of Organization in Rhode Island: 23 Sep 2002 (23 years ago)
Date of Dissolution: 08 Nov 2024 (5 months ago)
Date of Status Change: 08 Nov 2024 (5 months 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

Industry & Business Activity

NAICS

621111 Offices of Physicians (except Mental Health Specialists)

This U.S. industry comprises establishments of health practitioners having the degree of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathy) primarily engaged in the independent practice of general or specialized medicine (except psychiatry or psychoanalysis) or surgery. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. Learn more at the U.S. Census Bureau

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 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 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 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

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
6162117700 2020-05-03 0165 PPP 118 DUDLEY ST, PROVIDENCE, RI, 02905-2403
Loan Status Date -
Loan Status Exemption 4
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 113469
Loan Approval Amount (current) 113469
Undisbursed Amount 0
Franchise Name -
Lender Location ID 9551
Servicing Lender Name Bank of America, National Association
Servicing Lender Address 100 N Tryon St, Ste 170, CHARLOTTE, NC, 28202-4024
Rural or Urban Indicator U
Hubzone Y
LMI Y
Business Age Description New Business or 2 years or less
Project Address PROVIDENCE, PROVIDENCE, RI, 02905-2403
Project Congressional District RI-02
Number of Employees 7
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 9551
Originating Lender Name Bank of America, National Association
Originating Lender Address CHARLOTTE, NC
Gender Unanswered
Veteran Unanswered
Forgiveness Amount -
Forgiveness Paid Date -
7104897707 2020-05-01 0165 PPP 118 DUDLEY ST, PROVIDENCE, RI, 02905-2403
Loan Status Date 2021-11-18
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 20833
Loan Approval Amount (current) 20833
Undisbursed Amount 0
Franchise Name -
Lender Location ID 9551
Servicing Lender Name Bank of America, National Association
Servicing Lender Address 100 N Tryon St, Ste 170, CHARLOTTE, NC, 28202-4024
Rural or Urban Indicator U
Hubzone Y
LMI Y
Business Age Description New Business or 2 years or less
Project Address PROVIDENCE, PROVIDENCE, RI, 02905-2403
Project Congressional District RI-02
Number of Employees 4
NAICS code 621111
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 9551
Originating Lender Name Bank of America, National Association
Originating Lender Address CHARLOTTE, NC
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 21133.79
Forgiveness Paid Date 2021-10-21

Date of last update: 10 Apr 2025

Sources: Rhode Island Department of State