Individual provider Active NPI

Freda Owusua Boateng, M.D.

  • Internal Medicine Physician
  • Bridgeport, CT
National Provider Identifier
1386832848
Registry record updated Dec 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
045811 Issued in CT
Practice address
267 Grant St
Bridgeport, CT 06610-2805
Phone
(203) 384-4677
Fax
(203) 384-3135
NPI assigned
Oct 10, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 045811 CT
Hospitalist Physician 208M00000X 045811 CT
Internal Medicine Physician 207R00000X 045811 CT Primary

Addresses

Primary practice location

267 Grant St
Bridgeport, CT 06610-2805

Mailing address

850 Mix Ave
Hamden, CT 06514-2102
Phone (203) 281-3500

Other practice location 1

20 York St
New Haven, CT 06510-3220
Phone (203) 688-4748

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20200123002861 CA Practitioner - Internal Medicine 5193893659 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

2500 Merced St
San Leandro, CA 94577-4201
Phone (510) 454-1000

Hospital & facility affiliations

  • Kaiser Foundation Hospital - Fremont Hospital, Fremont, CA, CCN 050512
  • Kaiser Foundation Hospital - San Leandro Hospital, San Leandro, CA, CCN 050777

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
045811CTMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Solano Gateway Medical Group Inc CurrentSince Feb 1, 2020 Accepting new patients
Quantum Healthcare Medical Associates Inc. Internal Medicine CurrentSince Dec 16, 2019 Accepting new patients
Permanente Medical Group, Inc CurrentSince Dec 22, 2020 Accepting new patients
Permanente Medical Group Inc Internal Medicine Current Accepting new patients
Complete Health LLC Internal Medicine Current Accepting new patients
Quantum Bay Area Hospitalist Medical Group Inc Internal Medicine CurrentSince Aug 16, 2020 Accepting new patients
Permanente Medical Group Inc Internal Medicine CurrentSince Dec 22, 2020 Accepting new patients

Locations

750 Auburn Ravine Rd
Auburn, CA 95603
Phone (530) 823-6131

1200 B Gale Wilson Blvd
Fairfield, CA 94533
Phone (707) 429-3600

4753 W Shaw Ave
Ste 101
Fresno, CA 93722
Phone (559) 277-8738

900 N Douty St
Hanford, CA 93230
Phone (559) 587-9014

2500 Grant Rd
Mountain View, CA 94040
Phone (650) 903-9500

101 Monroe St
Petaluma, CA 94954
Phone (707) 763-4109

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

930 W Main St
Ripon, CA 95366
Phone (209) 599-4221

501 J St
Sacramento, CA 95814
Phone (916) 497-3000

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

225 N Jackson Ave
San Jose, CA 95116
Phone (408) 347-4051

2500 Merced St
San Leandro, CA 94577
Phone (510) 454-1000

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

5615 Scotts Valley Dr
Scotts Valley, CA 95066
Phone (831) 430-2700

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

1000 Nut Tree Rd
Vacaville, CA 95687
Phone (707) 446-4000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

320 N Crawford St
Willows, CA 95988
Phone (530) 934-2834

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Totality Home Health Care Agency LLCMilford, CT, CCN 077262 Home health agency 5% Or Greater Direct Ownership Interest (25%) Feb 1, 2013

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

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 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": "1191974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1386832848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 MIX AVE",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065142102",
            "telephone_number": "203-281-3500",
            "fax_number": "203-688-4740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "267 GRANT ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066102805",
            "telephone_number": "203-384-4677",
            "fax_number": "203-384-3135"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 York St",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "065103220",
            "country_code": "US",
            "telephone_number": "203-688-4748",
            "fax_number": "203-688-4740",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOATENG",
        "first_name": "FREDA",
        "middle_name": "OWUSUA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-10",
        "last_updated": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "045811",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CT",
            "license": "045811",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "045811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2500 Merced St",
            "city": "San Leandro",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945774201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

Verify at the official NPI Registry.