Adam Badillo, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

License

F4477436 Issued in TX

Practice address

600 Meridian Street Ext Apt 1415
Groton, CT 06340-4160

Phone

(619) 717-1658

NPI assigned

Jul 22, 2015

Last updated

Jul 22, 2015By the provider in NPPES

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1437523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437523200000",
    "number": "1265817175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 MERIDIAN STREET EXT APT 1415",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063404160",
            "telephone_number": "619-717-1658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 MERIDIAN STREET EXT APT 1415",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063404160",
            "telephone_number": "619-717-1658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BADILLO",
        "first_name": "ADAM",
        "name_prefix": "Mr.",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-22",
        "last_updated": "2015-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": "TX",
            "license": "F4477436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter T Auerbach, MD
• Kyrah Augmon-Bossa, LMSW
• Corydon Ali Awwa, LMFT
• Brianna Ba, PHARMD
• Jennifer N Back, RD, CDE
• Shawne L Baker, LCSW
• Balance & Bloom Therapy LLC
• Kathleen M Balantic, APRN
• Anandhi Baleswaren, MD
• Samantha Gwendolyn Ball, LCSW

• Independent Duty Corpsman in Groton, CT
• Providers in Groton, CT by specialty
• Independent Duty Corpsman in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.