Individual provider Active NPI

Vida Agyeman-Badu, RDN, LDN

  • Registered Dietitian
  • Richton Park, IL
National Provider Identifier
1124766803
Registry record updated May 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
164004130 Issued in IL
Practice address
22817 East Dr
Richton Park, IL 60471-2311
Phone
(708) 717-9968
NPI assigned
May 23, 2022
Last updated
May 23, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 164004130 IL Primary

Addresses

Primary practice location

22817 East Dr
Richton Park, IL 60471-2311

Mailing address

22817 East Dr
Richton Park, IL 60471-2311
Phone (708) 717-9968

Other practice location 1

6160 N Cicero Ave
Chicago, IL 60646-4312
Phone (888) 785-7370

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220629003815 IL Practitioner - Registered Dietitian Or Nutrition Professional 8820478316 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ad Medical Supply IncGroup PAC ID 0648173120, 5 clinicians

Practice addresses (Care Compare)

6160 N Cicero Ave
Suite 503
Chicago, IL 60646-4327
Phone (773) 292-1940

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ad Medical Supply, Inc. Dietitian, Registered CurrentSince May 24, 2022 Accepting new patients

Locations

6160 N Cicero Ave
Ste 503
Chicago, IL 60646
Phone (773) 292-1940

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1653264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653264000000",
    "number": "1124766803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22817 EAST DR",
            "city": "RICHTON PARK",
            "state": "IL",
            "postal_code": "604712311",
            "telephone_number": "708-717-9968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22817 EAST DR",
            "city": "RICHTON PARK",
            "state": "IL",
            "postal_code": "604712311",
            "telephone_number": "708-717-9968"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6160 N Cicero Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606464312",
            "country_code": "US",
            "telephone_number": "888-785-7370",
            "fax_number": "888-785-7380",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AGYEMAN-BADU",
        "first_name": "VIDA",
        "credential": "RDN, LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-23",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164004130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richton Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.