NPIMap

Individual provider Active NPI

Samuel Babatunde Adegboyega, DPM

  • Foot & Ankle Surgery Podiatrist
  • East Orange, NJ
National Provider Identifier
1124281233
Registry record updated Nov 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
25MD00306200 Issued in NJ
Practice address
310 Central Ave Ste 102
East Orange, NJ 07018-2838
Phone
(973) 207-1678
Fax
(732) 862-1242
NPI assigned
Jul 8, 2008
Last updated
Nov 3, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 3, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 006368 NY
Foot & Ankle Surgery Podiatrist 213ES0103X 25MD00306200 NJ Primary

Addresses

Primary practice location

310 Central Ave Ste 102
East Orange, NJ 07018-2838

Mailing address

83 Aberdeen Rd
Matawan, NJ 07747-2720
Phone (973) 207-1678

Other identifiers 1

IdentifierTypeStateIssuer
25MD00306200OtherNJMEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20101102001454 NY Practitioner - Podiatry 8325232408 Reassigns benefits to 3 organizations
I20110412000164 NJ Practitioner - Podiatry 8325232408 Reassigns benefits to 1 organization
Practice locations: East Orange, NJ

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
New York College of Podiatric Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

310 Central Ave
Suite 102
East Orange, NJ 07018-2838
Phone (973) 207-1678

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Oxford Foot and Ankle Specialists Foot & Ankle Surgery CurrentSince Aug 26, 2020 Accepting new patients
Harlem Medical Associates PC CurrentSince Aug 5, 2014 Accepting new patients
Downtown Bronx Medical Associates PC CurrentSince Apr 7, 2011 Accepting new patients

Locations

310 Central Ave
Ste 102
East Orange, NJ 07018
Phone (973) 207-1678

234 Eugenio Maria de Hosto Blvd
Bronx, NY 10451
Phone (718) 579-5874

506 Malcolm X Blvd
New York, NY 10037
Phone (212) 939-1000

45 Research Way
Ste 206
Setauket, NY 11733
Phone (631) 575-9300

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: sadegboyega671763@nychhc.direct-ci.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1215475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604361600000",
    "number": "1124281233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "83 ABERDEEN RD",
            "city": "MATAWAN",
            "state": "NJ",
            "postal_code": "077472720",
            "telephone_number": "973-207-1678",
            "fax_number": "732-862-1242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 CENTRAL AVE STE 102",
            "city": "EAST ORANGE",
            "state": "NJ",
            "postal_code": "070182838",
            "telephone_number": "973-207-1678",
            "fax_number": "732-862-1242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADEGBOYEGA",
        "first_name": "SAMUEL",
        "middle_name": "BABATUNDE",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-08",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NY",
            "license": "006368",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NJ",
            "license": "25MD00306200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "25MD00306200",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Orange, NJ

Sources for this page

Verify at the official NPI Registry.