Samuel Babatunde Adegboyega, DPM
Individual provider Active NPI Foot & Ankle Surgery Podiatrist · East Orange, NJ
NPI 1124281233 · NPPES record last updated Nov 3, 2020
Key facts
- NPI
- 1124281233
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Foot & Ankle Surgery Podiatrist 213ES0103X
- License
- 25MD00306200 (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
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Hospital & facility affiliations 5
Medicare Care Compare profile
- 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
- Carewell Health Medical Center
- Harlem Hospital Center
- Hackensack University Medical Center
- St Mary'S General Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 1-10 |
| Removal of nail tissue | 1-10 |
| Removal or shaving of skin growth | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY, NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles (3 of 7)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harlem Medical Associates PC | Current |
Accepting new patients | |
| Downtown Bronx Medical Associates PC | Current |
Accepting new patients | |
| Oxford Foot and Ankle Specialists | Foot & Ankle Surgery | Current |
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 H9678
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H5989
Interoperability endpoints
- sadegboyega671763@nychhc.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 006368 | NY | |
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 25MD00306200 | NJ | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 25MD00306200 | Other | NJ | MEDICAL LICENSE |
Other providers in East Orange, NJ
- Rosetta Abraham
- Adrienne B Abramowitz
- Access Family Services, Inc.
- Iris Berangell Acosta Amezquita
- Acumedcare, Corp.
- Rilwan Adigun
- Adorable Healthcare Services
- Aniesh M Adorno
- Advanced Home Health Services
- Advantage Health and Social Services LLC
All providers in East Orange, NJ · Foot & Ankle Surgery Podiatrist in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.