Individual provider Active NPI

Norah Adeyemi, PA-C

  • Physician Assistant
  • Lillington, NC
National Provider Identifier
1265909253
Registry record updated Feb 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-08797 Issued in NC
Practice address
40 Autumn Fern TRL
Lillington, NC 27546-5155
Phone
(910) 364-0971
NPI assigned
Oct 27, 2018
Last updated
Feb 11, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA6813 MA
Physician Assistant 363A00000X 0010-08797 NC Primary

Addresses

Primary practice location

40 Autumn Fern TRL
Lillington, NC 27546-5155

Mailing address

21 Oak Ridge Ave Apt 1
Salem, NH 03079-4424
Phone (603) 264-3095

Other practice location 1

21 Oak Ridge Ave Apt 1
Salem, NH 03079-4424
Phone (603) 264-3095

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190422000884 MA Practitioner - Physician Assistant 9537401674 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Boston University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

103 Garland St
Everett, MA 02149-5066
Phone (617) 389-6270

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA6813MAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Steward Medical Group, Inc CurrentSince May 15, 2019 Accepting new patients
Cambridge Public Health Commission CurrentSince Apr 13, 2021 Accepting new patients
Steward Medical Group, Inc CurrentSince May 15, 2019 Accepting new patients
Cambridge Public Health Commission CurrentSince Apr 13, 2021 Accepting new patients

Locations

11 Nevins St
Ste 201
Brighton, MA 02135
Phone (617) 789-2442

237 Hampshire St
Cambridge, MA 02139
Phone (617) 575-5570

103 Garland St
Everett, MA 02149
Phone (617) 381-7150

2067 Massachusetts Ave
North Cambridge, MA 02140
Phone (617) 575-5550

9 Galen St
Watertown, MA 02472
Phone (617) 562-5413

Interoperability endpoints

  • Direct secure messaging: nadeyemi@fcchc.directbygreenway.com
  • Direct secure messaging: nadeyemi111441@direct.challiance.masshiway.net

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 2

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": "1540598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549843200000",
    "number": "1265909253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 OAK RIDGE AVE APT 1",
            "city": "SALEM",
            "state": "NH",
            "postal_code": "030794424",
            "telephone_number": "603-264-3095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 AUTUMN FERN TRL",
            "city": "LILLINGTON",
            "state": "NC",
            "postal_code": "275465155",
            "telephone_number": "910-364-0971"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21 Oak Ridge Ave Apt 1",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "NH",
            "postal_code": "030794424",
            "country_code": "US",
            "telephone_number": "603-264-3095",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADEYEMI",
        "first_name": "NORAH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-27",
        "last_updated": "2019-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA6813",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-08797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lillington, NC

Sources for this page

Verify at the official NPI Registry.