Kofi Adade-Boafo, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A77940 Issued in CA

Practice address

2150 N Waterman Ave
Ste 200
San Bernardino, CA 92404-4811

Phone

(909) 887-7951

Fax

(909) 883-1634

NPI assigned

Nov 17, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DFCBAA
• Direct secure messaging: kofiadadeboafo@pmgca.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pinnacle Medical Group, Inc

  dba Optum

  • Family Medicine Physician
  • Fontana, CA
  • NPI 1376876912

  Pediatrics

  Medicare reassignment NPD
• Pinnacle Medical Group, Inc

  • Family Medicine Physician
  • Fontana, CA
  • NPI 1043255763

  Pediatrics

  NPD
• Pinnacle Medical Group, Inc.

  • Family Medicine Physician
  • San Bernardino, CA
  • NPI 1447292248

  Pediatrics

  NPD (past)
• United Family Care

  • Internal Medicine Physician
  • Fontana, CA
  • NPI 1629027255

  Pediatrics

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445558400000",
    "number": "1003898792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12209",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924232209",
            "telephone_number": "909-335-4188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 N WATERMAN AVE",
            "address_2": "STE 200",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924044811",
            "telephone_number": "909-887-7951",
            "fax_number": "909-883-1634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADADE-BOAFO",
        "first_name": "KOFI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-17",
        "last_updated": "2015-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A77940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD LICENSE",
            "identifier": "A77940",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eyizah Acquaye
• Arcadio S Acuna Jr.
• Crystal Veronica Acuna
• Gloria Acuna
• Fatemeh Adabifirouzjaei, MD
• Jenna Rheann Adair
• Adame & Adame, D.D.S.
• Alisa Victoria Adame
• Ariana Gisell Adame
• David Filippini Adame, DDS

• Pediatrics Physician in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.