Adetunji Adegboyega, M.D
Individual provider Active NPI Family Medicine Physician · Aurora, IL
NPI 1386084077 · NPPES record last updated Nov 29, 2021
Key facts
- NPI
- 1386084077
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 125.064037 (IL)
- Practice address
- 2020 Ogden Ave Ste 325
Aurora, IL 60504-5897 - Phone
- (630) 978-4850
- Fax
- (630) 978-6865
- NPI assigned
- Jun 27, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southern California Permanente Medical Group
Practice addresses (Care Compare)
1183 E Foothill Blvd
Upland, CA 91786-4079
Phone (909) 367-7000
9961 Sierra Ave
Fontana, CA 92335-6720
Phone (909) 427-5000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in CA, OR, WA
- 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 |
|---|---|---|---|---|
| I20161021000663 | CA | Practitioner - Family Practice | 0446556617 | Reassigns benefits to 1 organization |
| I20260511002100 | OR | Practitioner - Family Practice | 0446556617 | Reassigns benefits to 1 organization |
| I20260511002122 | WA | Practitioner - Family Practice | 0446556617 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 139622 | CA | MD | Marriage & Family Therapist |
| 125.064037 | IL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| Southern California Permanente Medical Group | Current | Accepting new patients | |
| Copley Memorial Hospital Inc. | Family Medicine | Past |
Accepting new patients |
Locations
9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910
393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 125.064037 | IL | Yes |
Addresses
Primary practice location
2020 Ogden Ave Ste 325
Aurora, IL 60504-5897
Mailing address
2020 Ogden Ave
Ste 325
Aurora, IL 60504-5894
Phone (215) 500-4848
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq | Health Information Exchange (HIE) | Southern California Permanente Medical Group |
Other providers in Aurora, IL
- Frank Robert Acton
- Allison Sharee Adair
- Sharon Adams
- Mayank R Adatia
- Shakuntala M Adatia
- Babajide Idowu Adeleye
- Laura Ann Adeli
- Payam Victor Aderangi
- Ruaa Adham
- Lauren Lynn Adolfino
All providers in Aurora, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2021. 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.