Samuel O Fadare Jr., MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

103939 Issued in MO

Practice address

5604 NE Antioch Rd
Gladstone, MO 64119-2327

Phone

(660) 372-1313

Fax

(660) 372-1339

NPI assigned

Mar 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in KS, MO, GA3 enrollments

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 3

Specialty

Psychiatry

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Samuel O Fadare MD PAGroup PAC ID 3072615525, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/BCEGCD
• Direct secure messaging: sfadare@landmarkhealth-direct.org

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.

• Samuel O Fadare, MD, PA

  • Adult Mental Health Clinic/Center
  • Gladstone, MO
  • NPI 1639287824

  KS, Psychiatry

  Medicare reassignment Care Compare group NPD Authorized official
• Family Guidance Center for Behavioral Healthcare

  • Community/Behavioral Health Agency
  • Saint Joseph, MO
  • NPI 1932225141
  Medicare reassignment NPD
• Swope Health Services

  • Federally Qualified Health Center (FQHC)
  • Kansas City, MO
  • NPI 1689760076
  Medicare reassignment NPD
• Mobolaji Shalom Oyebanjo, Inc

  • Psychiatry Physician
  • Villa Rica, GA
  • NPI 1922280684
  Medicare reassignment NPD
• Oak Hills Behavioral Health Solutions

  • Counselor
  • Moberly, MO
  • NPI 1710544416
  Medicare reassignment
• Swope Health Services

  • Federally Qualified Health Center (FQHC)
  • Kansas City, MO
  • NPI 1285404434
  NPD
• Swope Health Services

  • Federally Qualified Health Center (FQHC)
  • Riverside, MO
  • NPI 1568557205
  NPD
• Family Guidance Center for Behavioral Healthcare

  • Community/Behavioral Health Agency
  • Saint Joseph, MO
  • NPI 1164964235
  NPD (past)
• FSS Psychiatric, LLC

  • Psychiatry Physician
  • Lenexa, KS
  • NPI 1699730846
  NPD (past)
• Potters Hands Institute LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Villa Rica, GA
  • NPI 1386964690
  NPD (past)

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1184685802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1513 UNION AVE STE 2500",
            "city": "MOBERLY",
            "state": "MO",
            "postal_code": "652709412",
            "telephone_number": "660-372-1313",
            "fax_number": "660-372-1339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5604 NE ANTIOCH RD",
            "city": "GLADSTONE",
            "state": "MO",
            "postal_code": "641192327",
            "telephone_number": "660-372-1313",
            "fax_number": "660-372-1339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADARE",
        "first_name": "SAMUEL",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "KS",
            "license": "04-24672",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301063006",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "90387",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME157175",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "103939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Elliott
• Empowered Counseling LLC
• Penny J Engstrom, LCSW
• Kathryn Etter
• Taina Melissa Eveillard
• Colleen Fagan, PH.D.
• Kendra Fagan, RN
• Faith Healthcare LLC
• Faith Hospice & Palliative Care LLC
• Farmers Agent LLC

• Psychiatry Physician in Gladstone, MO
• Providers in Gladstone, MO by specialty
• Psychiatry Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.