Individual provider Active NPI

Edjah Nduom, MD

  • Neurological Surgery Physician
  • Bethesda, MD
National Provider Identifier
1285802801
Registry record updated Dec 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
85703 Issued in GA
Practice address
10 Center Dr 10/3D20, MSC 1414
Bethesda, MD 20892-1013
Phone
(301) 496-2921
NPI assigned
Feb 17, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 002213 GA
Neurological Surgery Physician 207T00000X 85703 GA Primary
Neurological Surgery Physician 207T00000X P9918 TX

Addresses

Primary practice location

10 Center Dr 10/3D20, MSC 1414
Bethesda, MD 20892-1013

Mailing address

1365B Clifton Rd NE
Suite 6400
Atlanta, GA 30322-1013

Other identifiers 2

IdentifierTypeStateIssuer
8EJ129 (MDACC)OtherTXBCBS
335993701 (MDACC)MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, GA2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20190315002103 VA Practitioner - Neurosurgery 3476777673
I20201211002098 GA Practitioner - Neurosurgery 3476777673 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Emory Clinic IncGroup PAC ID 8820901408, 3,507 clinicians

Practice addresses (Care Compare)

1365 Clifton Rd NE
Atlanta, GA 30322-1013
Phone (404) 778-7525

Hospital & facility affiliations

  • Emory University Hospital Hospital, Atlanta, GA, CCN 110010
  • Emory University Hospital Midtown Hospital, Atlanta, GA, CCN 110078
  • Emory Decatur Hospital Hospital, Decatur, GA, CCN 110076

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
002213GAMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emory Medical Care Foundation Inc CurrentSince Sep 1, 2020 Accepting new patients
The Emory Clinic Inc CurrentSince Sep 1, 2020 Accepting new patients
Emory Medical Care Foundation Inc CurrentSince Sep 1, 2020 Accepting new patients
Emory Health Care Past Accepting new patients
Emory University Past Accepting new patients

Locations

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

1365 Clifton Rd NE
Ste 6400
Atlanta, GA 30322

1365 Clifton Rd NE
Ste B2200
Atlanta, GA 30322
Phone (404) 778-5770

101 W Ponce de Leon Ave
Decatur, GA 30030
Phone (404) 778-4889

Interoperability endpoints

  • Direct secure messaging: enduom21815@direct.emory.org

Organizations & group practices 5

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.

Hospital & facility affiliations 4

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": "1203206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1285802801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1365B CLIFTON RD NE",
            "address_2": "SUITE 6400",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303221013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 CENTER DR 10/3D20, MSC 1414",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208921013",
            "telephone_number": "301-496-2921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NDUOM",
        "first_name": "EDJAH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-17",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "GA",
            "license": "002213",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "GA",
            "license": "85703",
            "primary": true
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "TX",
            "license": "P9918",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8EJ129  (MDACC)",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "335993701  (MDACC)",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethesda, MD

Sources for this page

Verify at the official NPI Registry.