Individual provider Active NPI

Adam Joseph Badaczewski, DPM

  • Podiatrist
  • Winston Salem, NC
National Provider Identifier
1255726071
Registry record updated Aug 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
706 Issued in NC
Practice address
3057 Trenwest Dr
Winston Salem, NC 27103-3220
Phone
(336) 765-0710
Fax
(336) 765-0821
NPI assigned
Mar 30, 2015
Last updated
Aug 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X SC006652 PA
Primary Podiatric Medicine Podiatrist 213EP1101X 706 NC
Foot & Ankle Surgery Podiatrist 213ES0103X SC006652 PA
Podiatrist 213E00000X 706 NC Primary

Addresses

Primary practice location

3057 Trenwest Dr
Winston Salem, NC 27103-3220

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other identifiers 1

IdentifierTypeStateIssuer
103485196MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address abadaczewski738485@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191112003554 NC Practitioner - Podiatry 3577860329 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians

Practice addresses (Care Compare)

200 Hawthorne LN
Charlotte, NC 28204-2515
Phone (704) 384-5416

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Melanoma (skin cancer) excision1-10
Removal of tissue41
Removal of skin lesions33
Removal of nail tissue420
Removal or shaving of skin growth293

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
706NCMDPrimary Podiatric Medicine Podiatrist
SC006652PAMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Sep 3, 2019 Accepting new patients
Novant Health Medical Group, LLC Podiatrist CurrentSince Sep 3, 2019 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

4741 Randolph Rd
#100
Charlotte, NC 28211
Phone (704) 365-6730

7126 Village Medical Cir
Clemmons, NC 27012
Phone (336) 448-2427

445 Pineview Dr
Ste 230
Kernersville, NC 27284
Phone (336) 760-3007

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

3057 Trenwest Dr
Winston Salem, NC 27103
Phone (336) 765-0710

Interoperability endpoints

  • Direct secure messaging: abadaczewski738485@direct.novanthealth.org

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 1

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": "1427673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1255726071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3057 TRENWEST DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271033220",
            "telephone_number": "336-765-0710",
            "fax_number": "336-765-0821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BADACZEWSKI",
        "first_name": "ADAM",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-30",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "PA",
            "license": "SC006652",
            "primary": false
        },
        {
            "code": "213EP1101X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "NC",
            "license": "706",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "PA",
            "license": "SC006652",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NC",
            "license": "706",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103485196",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "abadaczewski738485@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "3057 Trenwest Dr",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271033220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.