Individual provider Active NPI

Bonte Gbemudu, M.D.

  • Family Medicine Physician
  • Goodyear, AZ
National Provider Identifier
1104137256
Registry record updated Jun 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
54480 Issued in AZ
Practice address
13471 W Cornerstone Blvd
Goodyear, AZ 85395-2713
Phone
(877) 809-5092
Fax
(623) 213-8808
NPI assigned
Jun 23, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2019

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 54480 AZ Primary

Addresses

Primary practice location

13471 W Cornerstone Blvd
Goodyear, AZ 85395-2713

Mailing address

3033 N Central Ave Ste 145
Phoenix, AZ 85012-2808
Phone (877) 809-5092

Other identifiers 1

IdentifierTypeStateIssuer
298755MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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

Enrollment IDStateProvider typePAC IDDetails
I20170822003782 AZ Practitioner - Family Practice 9335377720 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
State University of New York at Stony Brook, School of Medicine, 2010
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

923 Senior Circle
Macy, NE 68039-4018

PO Box
Suite 250
Macy, NE 68039-0250

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
54480AZMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adelante Healthcare, Inc. Family Medicine CurrentSince Apr 1, 2019 Accepting new patients
Adelante Healthcare, Inc CurrentSince Apr 1, 2019 Accepting new patients
Adelante Healthcare, Inc. Family Medicine Current Accepting new patients
Signify Health, LLC CurrentSince May 15, 2024 Accepting new patients

Locations

306 E Monroe Ave
Buckeye, AZ 85326
Phone (623) 386-4814

2705 S Alma School Rd
Chandler, AZ 85286
Phone (480) 820-7246

13471 W Cornerstone Blvd
Goodyear, AZ 85395

1705 W Main St
Mesa, AZ 85201
Phone (480) 845-6769

15525 N 83rd Ave
Ste 104
Peoria, AZ 85382

500 W Thomas Rd
Ste 870
Phoenix, AZ 85013
Phone (602) 263-0222

3033 N Central Ave
Ste 145
Phoenix, AZ 85012

7725 N 43rd Ave
Ste 510
Phoenix, AZ 85051
Phone (623) 207-5465

15351 W Bell Rd
Surprise, AZ 85374

15317 W Bell Rd
Ste 100
Surprise, AZ 85374

811 N Tegner St
Ste 113
Wickenburg, AZ 85390

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559520000000",
    "number": "1104137256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3033 N CENTRAL AVE STE 145",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122808",
            "telephone_number": "877-809-5092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13471 W CORNERSTONE BLVD",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952713",
            "telephone_number": "877-809-5092",
            "fax_number": "623-213-8808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GBEMUDU",
        "first_name": "BONTE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-23",
        "last_updated": "2019-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "54480",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "298755",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goodyear, AZ

Sources for this page

Verify at the official NPI Registry.