Enyonam Agamasu, M.D.
Individual provider Active NPI Obstetrics & Gynecology Physician · Mesa, AZ
NPI 1295023935 · NPPES record last updated May 17, 2023
Key facts
- NPI
- 1295023935
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 57816 (AZ)
- Practice address
- 1705 W Main St
Mesa, AZ 85201-6920 - Phone
- (480) 964-2273
- NPI assigned
- Jul 15, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 15
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Adelante Healthcare, Inc
Practice addresses (Care Compare)
1705 W Main St
Mesa, AZ 85201-6920
Phone (877) 809-5092
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190829003832 | AZ | Practitioner - Obstetrics/Gynecology | 7214222496 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57816 | AZ | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Adelante Healthcare, Inc. | Family Medicine | Current | Accepting new patients |
| Adelante Healthcare, Inc. | Family Medicine | Current |
Accepting new patients |
| Adelante Healthcare, Inc | Current |
Accepting new patients | |
| Banner Desert Medical Center | Past | Accepting new patients | |
| Adelante Healthcare, Inc. | Family Medicine | Past | Accepting new patients |
Locations
13471 W Cornerstone Blvd
Goodyear, AZ 85395
1705 W Main St
Mesa, AZ 85201
Phone (480) 845-6769
3033 N Central Ave
Ste 145
Phoenix, AZ 85012
15317 W Bell Rd
Ste 100
Surprise, AZ 85374
15351 W Bell Rd
Surprise, AZ 85374
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 57816 | AZ | Yes |
Addresses
Primary practice location
1705 W Main St
Mesa, AZ 85201-6920
Mailing address
3033 N Central Ave Ste 145
Phoenix, AZ 85012-2808
Phone (623) 583-3001
Other providers in Mesa, AZ
- Affordable Dentures - Mesa, P.C.
- Affordable Dentures & Implants - Mesa II, P.C.
- Affordable Medical Transport LLC
- Aga Medicar Professional Services,Inc
- Against All Odds Integrated Community Care
- Agape Healing House, LLC
- Agape Treatment Center LLC
- Agave Center for Behavioral Health PLLC
- Agave Medical Group PLLC
- Agave Surgical Services LLC
All providers in Mesa, AZ · Obstetrics & Gynecology Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 17, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.