Khadijat Omolola Balogun, M.D

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

56518 Issued in CT

Practice address

353 Main St
Manchester, CT 06040-4145

Phone

(860) 649-3477

Fax

(860) 649-0011

NPI assigned

May 16, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

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

Specialty

Gastroenterology

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gastrointestinal Associates of Maryland PAGroup PAC ID 7911079181, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventist Healthcare Fort Washington Medical Ctr Hospital, Fort Washington, MD, CCN 210060

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Gastrointestinal Associates of Maryland PA

  • Gastroenterology Physician
  • Waldorf, MD
  • NPI 1164404125
  Medicare reassignment Care Compare group

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

• Adventist Healthcare Fort Washington Medical Center Inc

  • General Acute Care Hospital
  • Ft Washington, MD
  • NPI 1932146461
  Care Compare affiliation

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

{
    "created_epoch": "1305504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1124310743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "353 MAIN ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060404145",
            "telephone_number": "860-649-3477",
            "fax_number": "860-649-0011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "353 MAIN ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060404145",
            "telephone_number": "860-649-3477",
            "fax_number": "860-649-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALOGUN",
        "first_name": "KHADIJAT",
        "middle_name": "OMOLOLA",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-16",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CT",
            "license": "56518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronald Baker
• Gilbert R Balatbat, M.D.
• Kodilichi VJ Baldino, MD
• Dacia R Ball
• Nikkeia I Ball
• Anjali Anand Banerjee, DMD
• Maria Banevicius, APRN
• Joella Banker
• Kelly Banning
• Nikita T Bansal

• Gastroenterology Physician in Manchester, CT
• Providers in Manchester, CT by specialty
• Gastroenterology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.