NPIMap

Individual provider Active NPI

Aidevo Sandra Igbide, MD

  • Family Medicine Physician
  • Henderson, NC
National Provider Identifier
1093226649
Registry record updated Oct 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2017-01431. Issued in NC
Practice address
511 Ruin Creek Rd Ste 101
Henderson, NC 27536-5919
Phone
(919) 813-6367
NPI assigned
Oct 21, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2017-01431. NC Primary

Addresses

Primary practice location

511 Ruin Creek Rd Ste 101
Henderson, NC 27536-5919

Mailing address

566 Ruin Creek Rd
Henderson, NC 27536-2927

Other names 1

  • Dr. Aidevo Sandra Adebo Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171211000552 NC Practitioner - Family Practice 9335407840 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atrium Health North Market Network LLCGroup PAC ID 1557743440, 158 clinicians

Practice addresses (Care Compare)

4815 Johnston Oehler Rd
Suite 100
Charlotte, NC 28269-1065
Phone (704) 801-7310

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2017-01431.NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Specialty Physicians LLC CurrentSince Apr 12, 2021 Accepting new patients
Wake Specialty Physicians, LLC Family Medicine Current Accepting new patients
Atrium Health North Market Network LLC Family Medicine CurrentSince Oct 2, 2023 Accepting new patients
DLP Maria Parham Physician Practices LLC CurrentSince Nov 4, 2017 Accepting new patients
Wake Specialty Physicians LLC Family Medicine CurrentSince Apr 12, 2021 Accepting new patients
DLP Maria Parham Physician Practices, LLC Family Medicine CurrentSince Nov 4, 2017 Accepting new patients
Carolinas Physicians Network Inc Family Medicine Past Accepting new patients

Locations

4525 Cameron Valley Pkwy
Ste 4100D
Charlotte, NC 28211
Phone (704) 801-7310

4815 Johnston Oehler Rd
#100
Charlotte, NC 28269
Phone (704) 801-7310

566 Ruin Creek Rd
Henderson, NC 27536
Phone (252) 436-1352

120 Charles Rollins Rd
Ste 105
Henderson, NC 27536
Phone (252) 438-2773

511 Ruin Creek Rd
Ste 101
Henderson, NC 27536
Phone (252) 436-0440

10000 Falls of Neuse Rd
Raleigh, NC 27614
Phone (919) 350-1300

10000 Falls of Neuse Rd
Ste 205
Raleigh, NC 27614
Phone (919) 350-1630

2930 Forestville Rd
Raleigh, NC 27616
Phone (919) 235-6500

Interoperability endpoints

  • Direct secure messaging: aigbide347433@directhisp.wakemed.org
  • Direct secure messaging: aigbide2736107@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 7

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 9

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": "1508544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508544000000",
    "number": "1093226649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "566 RUIN CREEK RD",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275362927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 RUIN CREEK RD STE 101",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275365919",
            "telephone_number": "919-813-6367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IGBIDE",
        "first_name": "AIDEVO",
        "middle_name": "SANDRA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-21",
        "last_updated": "2017-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2017-01431.",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AIDEVO",
            "last_name": "ADEBO",
            "middle_name": "SANDRA",
            "prefix": "DR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Henderson, NC

Sources for this page

Verify at the official NPI Registry.