NPIMap

Individual provider Active NPI

Chiduzie C. Madubata, M.D.

  • Cardiovascular Disease Physician
  • Philadelphia, PA
National Provider Identifier
1053639344
Registry record updated Jul 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MD453717 Issued in PA
Practice address
1200 W Tabor Rd FL 3
Philadelphia, PA 19141-3019
Phone
(215) 456-3930
Fax
(215) 456-1432
NPI assigned
May 11, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X MD453717 PA Primary
Cardiovascular Disease Physician 207RC0000X 0101275142 VA

Addresses

Primary practice location

1200 W Tabor Rd FL 3
Philadelphia, PA 19141-3019

Mailing address

101 E Olney Ave
Ste 400
Philadelphia, PA 19120-2470
Phone (215) 456-7000

Other practice location 1

600 Gresham Dr
Norfolk, VA 23507-1904
Phone (757) 388-8870

Other identifiers 1

IdentifierTypeStateIssuer
1032544200002MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, VA, IN3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20170901002482 PA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 8325288475 Reassigns benefits to 1 organization
I20220909003026 VA Practitioner - Cardiovascular Disease (Cardiology) 8325288475 Reassigns benefits to 1 organization
I20221104001300 IN Practitioner - Cardiovascular Disease (Cardiology) 8325288475 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Tufts University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Einstein Practice Plan IncGroup PAC ID 2769395896, 774 clinicians

Practice addresses (Care Compare)

9880 Bustleton Ave
Suite 220
Philadelphia, PA 19115-2143
Phone (215) 827-1500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD453717PAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Einstein Practice Plan Inc CurrentSince Jul 1, 2019 Accepting new patients
Lutheran Medical Group LLC CurrentSince Oct 26, 2022 Accepting new patients
Lutheran Medical Group LLC Internal Medicine CurrentSince Oct 26, 2022 Accepting new patients
Einstein Practice Plan Inc Cardiovascular Disease CurrentSince Jul 1, 2019 Accepting new patients
Sentara Medical Group Internal Medicine CurrentSince Aug 5, 2022 Accepting new patients
Einstein Practice Plan Inc Current Accepting new patients
Einstein Practice Plan Inc Past Accepting new patients
Albert Einstein Medical Center Past Accepting new patients

Locations

7950 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 434-7088

2516 E DuPont Rd
Fort Wayne, IN 46825
Phone (260) 434-6076

6920 Pointe Inverness Way
Ste 200
Fort Wayne, IN 46804
Phone (260) 479-3514

401 Township Line Rd
Ste A
Elkins Park, PA 19027
Phone (215) 663-1188

401 Township Line Rd
Ste A
Philadelphia, PA 19111
Phone (215) 663-1188

1200 W Tabor Rd
Fl 3
Philadelphia, PA 19141
Phone (215) 456-3930

5501 Old York Rd
Ste 3
Philadelphia, PA 19141
Phone (215) 456-7180

5501 York Rd
Philadelphia, PA 19141
Phone (215) 456-7405

101 E Olney Ave
Ste 400
Philadelphia, PA 19120
Phone (215) 254-2630

9880 Bustleton Ave
Ste 2
Philadelphia, PA 19115
Phone (215) 827-1500

9880 Bustleton Ave
Ste 220
Philadelphia, PA 19115
Phone (215) 456-7900

600 Gresham Dr
Norfolk, VA 23507
Phone (757) 473-0055

850 Kempsville Rd
Norfolk, VA 23502
Phone (757) 261-0162

Organizations & group practices 8

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.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1273536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657670400000",
    "number": "1053639344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E OLNEY AVE",
            "address_2": "STE 400",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191202470",
            "telephone_number": "215-456-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W TABOR RD FL 3",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191413019",
            "telephone_number": "215-456-3930",
            "fax_number": "215-456-1432"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Gresham Dr",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "VA",
            "postal_code": "235071904",
            "country_code": "US",
            "telephone_number": "757-388-8870",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MADUBATA",
        "first_name": "CHIDUZIE",
        "middle_name": "C.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-11",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "PA",
            "license": "MD453717",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "VA",
            "license": "0101275142",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1032544200002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.