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  5. BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC

BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC

Company Details

Name: BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC
Jurisdiction: Rhode Island
Entity type: Domestic Limited Liability Company
Status: Activ
Date of Organization in Rhode Island: 25 Mar 2003 (22 years ago)
Identification Number: 000130814
ZIP code: 02919
County: Providence County
Principal Address: 1526 ATWOOD AVENUE SUITE 200, JOHNSTON, RI, 02919, USA
Purpose: MEDICAL OFFICE
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)
Fictitious names: Spinal Therapeutics (trading name, 2004-09-23 - 2011-07-21)
Historical names: Sumit Das Neurological Surgery, LLC

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1558304212 2006-06-13 2019-04-18 25 THURBER BLVD, UNIT 6, SMITHFIELD, RI, 029171816, US 1526 ATWOOD AVENUE, SUITE 200, JOHNSTON, RI, 02919, US

Contacts
Phone +1 401-404-2975
Fax 4044042976
Phone +1 401-270-5395
Fax 4012707635

Authorized person
Name DR. SUMIT KUMAR DAS
Role PRESIDENT
Phone 4012705395

Taxonomy
Taxonomy Code 103T00000X - Psychologist
Is Primary No
Taxonomy Code 207T00000X - Neurological Surgery Physician
Is Primary Yes
Taxonomy Code 225100000X - Physical Therapist
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number SD50629
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC 401(K) PROFIT SHARING PLAN 2023 562331703 2024-10-13 BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 1526 ATWOOD AVENUE, JOHNSTON, RI, 02919
BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC CASH BALANCE PLAN 2023 562331703 2024-10-13 BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC 15
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 1526 ATWOOD AVENUE, JOHNSTON, RI, 02919
BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC 401(K) PROFIT SHARING PLAN 2022 562331703 2023-10-11 BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 1526 ATWOOD AVENUE, JOHNSTON, RI, 02919
BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC CASH BALANCE PLAN 2022 562331703 2023-10-11 BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC 12
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 1526 ATWOOD AVENUE, JOHNSTON, RI, 02919
BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC 401(K) PROFIT SHARING PLAN 2021 562331703 2022-10-05 BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 1526 ATWOOD AVENUE, JOHNSTON, RI, 02919
BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC CASH BALANCE PLAN 2021 562331703 2022-10-05 BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC 10
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 1526 ATWOOD AVENUE, JOHNSTON, RI, 02919
BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC CASH BALANCE PLAN 2020 562331703 2021-10-07 BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC 10
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 1526 ATWOOD AVENUE, JOHNSTON, RI, 02919
BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC 401(K) PROFIT SHARING PLAN 2020 562331703 2021-10-07 BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 1526 ATWOOD AVENUE, JOHNSTON, RI, 02919
BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC CASH BALANCE PLAN 2019 562331703 2020-10-15 BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC 9
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 1526 ATWOOD AVENUE, JOHNSTON, RI, 02919
BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC 401(K) PROFIT SHARING PLAN 2019 562331703 2020-10-15 BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 1526 ATWOOD AVENUE, JOHNSTON, RI, 02919
File https://efast2-filings-public.s3.amazonaws.com/prd/2019/10/14/20191014144940P040083200839001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 1526 ATWOOD AVENUE, JOHNSTON, RI, 02919
File https://efast2-filings-public.s3.amazonaws.com/prd/2019/10/14/20191014145355P040083212983001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 1526 ATWOOD AVENUE, JOHNSTON, RI, 02919
File https://efast2-filings-public.s3.amazonaws.com/prd/2018/10/15/20181015091003P030010408569001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 1526 ATWOOD AVENUE, JOHNSTON, RI, 02919
File https://efast2-filings-public.s3.amazonaws.com/prd/2018/10/15/20181015093016P040275827857001.pdf
Three-digit plan number (PN) 002
Effective date of plan 2017-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 1526 ATWOOD AVENUE, JOHNSTON, RI, 02919
File https://efast2-filings-public.s3.amazonaws.com/prd/2017/10/13/20171013133616P040166416813001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 1526 ATWOOD AVENUE, JOHNSTON, RI, 02919

Signature of
Role Plan administrator
Date 2017-10-13
Name of individual signing SUMIT DAS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2016/10/11/20161011193138P040019452727001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 1526 ATWOOD AVENUE, JOHNSTON, RI, 02919

Signature of
Role Plan administrator
Date 2016-10-11
Name of individual signing SUMIT DAS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/10/14/20151014094526P030032812045001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 1526 ATWOOD AVENUE, JOHNSTON, RI, 02919

Signature of
Role Plan administrator
Date 2015-10-14
Name of individual signing SUMIT DAS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/10/22/20141022160832P030023447039001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 25 THURBER BLVD., UNIT 6, SMITHFIELD, RI, 02917

Signature of
Role Plan administrator
Date 2014-10-22
Name of individual signing SUMIT DAS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/10/15/20131015093714P030017488117001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 25 THURBER BOULEVARD, UNIT 6, SMITHFIELD, RI, 02917

Signature of
Role Plan administrator
Date 2013-10-15
Name of individual signing SUMIT DAS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/10/11/20121011112009P040000734119001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 25 THURBER BOULEVARD, UNIT 6, SMITHFIELD, RI, 02917

Plan administrator’s name and address
Administrator’s EIN 562331703
Plan administrator’s name BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC
Plan administrator’s address 25 THURBER BOULEVARD, UNIT 6, SMITHFIELD, RI, 02917
Administrator’s telephone number 4014042975

Signature of
Role Plan administrator
Date 2012-10-11
Name of individual signing SUMIT DAS
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/10/17/20111017151111P040155047681001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 25 THURBER BOULEVARD UNIT 6, SMITHFIELD, RI, 02917

Plan administrator’s name and address
Administrator’s EIN 562331703
Plan administrator’s name BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC
Plan administrator’s address 25 THURBER BOULEVARD UNIT 6, SMITHFIELD, RI, 02917
Administrator’s telephone number 4014042975

Signature of
Role Plan administrator
Date 2011-10-17
Name of individual signing SUMIT DAS
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 001
Effective date of plan 2004-01-01
Business code 621111
Sponsor’s telephone number 4014042975
Plan sponsor’s address 25 THURBER BOULEVARD UNIT 6, SMITHFIELD, RI, 02917

Plan administrator’s name and address
Administrator’s EIN 562331703
Plan administrator’s name BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC
Plan administrator’s address 25 THURBER BOULEVARD UNIT 6, SMITHFIELD, RI, 02917
Administrator’s telephone number 4014042975

Signature of
Role Plan administrator
Date 2011-10-17
Name of individual signing SUMIT DAS
Valid signature Filed with incorrect/unrecognized electronic signature

Agent

Name Role Address
STEPHEN D. ZUBIAGO, ESQ. Agent NIXON PEABODY LLP ONE CITIZENS PLAZA SUITE 500, PROVIDENCE, RI, 02903, USA

Events

Type Date Old Value New Value
Name Change 2004-09-23 Sumit Das Neurological Surgery, LLC BRAIN AND SPINE NEUROSURGICAL INSTITUTE, LLC

Filings

Number Name File Date
202449370250 Annual Report 2024-03-25
202330254760 Annual Report 2023-03-07
202214263990 Annual Report 2022-04-04
202104368950 Annual Report 2021-10-28
202079023340 Annual Report 2020-12-07
201923994320 Annual Report 2019-10-09
201881898380 Annual Report 2018-11-29
201753203010 Annual Report 2017-11-09
201627923680 Annual Report 2016-11-23
201693246430 Annual Report 2016-02-26

Related by officers

STEPHEN D. ZUBIAGO, ESQ.

Nicholas A. Califano, M.D., Inc. CARDIOLOGY ASSOCIATES, INC. MIRIAM IPA, INC. ORTHOPEDIC GROUP, INC. Bayside Endoscopy Group, Inc. Mobile Storage Inc. H & H TRUCKING INC. MIRIAM PHO, INC. Bayside OB-GYN, Inc. West Bay Orthopaedics and Neurosurgery, Inc.

Related by address

1526 ATWOOD AVENUE SUITE 200, JOHNSTON, RI, 02919, USA

Ocean State Neuroscience Center, LLC Myelin, LLC SPINAL THERAPEUTICS, LLC Imaging RI, LLC

Date of last update: 09 Oct 2024

Sources: Rhode Island Department of State

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