NPIMap

Individual provider Active NPI

Fatai Adesina Gbadamosi, MD

  • Internal Medicine Physician
  • Buffalo, NY
National Provider Identifier
1386693190
Registry record updated Dec 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
248561 Issued in NY
Practice address
206 S Elmwood Ave
Buffalo, NY 14201-2398
Phone
(716) 847-0328
Fax
(716) 847-2715
NPI assigned
May 9, 2006
Last updated
Dec 9, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 248561 NY Primary

Addresses

Primary practice location

206 S Elmwood Ave
Buffalo, NY 14201-2398

Mailing address

206 S Elmwood Ave
Buffalo, NY 14201-2398
Phone (716) 847-0328

Other identifiers 4

IdentifierTypeStateIssuer
02050035MedicaidNY
0410964OtherNYINDEPENDENT HEALTH
00025064402OtherNYUNIVERA
000525978004OtherNYBLUE CROSS & BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050505000952 NY Practitioner - Internal Medicine 2769422062 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ehs, IncGroup PAC ID 7618946310, 41 clinicians

Practice addresses (Care Compare)

206 S Elmwood Ave
Buffalo, NY 14201-2398
Phone 71684724411716

2228 Delaware Ave
Suite 200
Buffalo, NY 14216-2618
Phone (716) 874-2273

7 Community Dr
Cheektowaga, NY 14225-2523
Phone (716) 847-2441

800 Hertel Ave
Buffalo, NY 14207-1906
Phone (716) 847-2441

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
248561NYMDInternal Medicine Physician
905NYMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Western New York Immediate Medical Care LLC CurrentSince Mar 20, 2008 Accepting new patients
Ehs, Inc. CurrentSince Sep 19, 2005 Accepting new patients
Western New York Immediate Medical Care LLC CurrentSince Mar 20, 2008 Accepting new patients

Locations

2099 Niagara Falls Blvd
Amherst, NY 14228
Phone (716) 204-2273

4988 Harlem Rd
Amherst, NY 14226
Phone (716) 564-2273

206 S Elmwood Ave
Buffalo, NY 14201
Phone (716) 847-0212

320 Prather Ave
Jamestown, NY 14701
Phone (716) 488-0776

Interoperability endpoints

  • Direct secure messaging: fgbadamosi@evergreenhs.medentdirect.com

Organizations & group practices 3

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 7

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": "1147132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323388800000",
    "number": "1386693190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 S ELMWOOD AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142012398",
            "telephone_number": "716-847-0328",
            "fax_number": "716-847-2715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 S ELMWOOD AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142012398",
            "telephone_number": "716-847-0328",
            "fax_number": "716-847-2715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GBADAMOSI",
        "first_name": "FATAI",
        "middle_name": "ADESINA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-09",
        "last_updated": "2011-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "248561",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02050035",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENT HEALTH",
            "identifier": "0410964",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00025064402",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "000525978004",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.