Individual provider Active NPI

Adam Buffington, DPM

  • Foot & Ankle Surgery Podiatrist
  • Crystal Lake, IL
National Provider Identifier
1396197604
Registry record updated Oct 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
016005830 Issued in IL
Practice address
750 E Terra Cotta Ave Ste C
Crystal Lake, IL 60014
Phone
(847) 639-5800
Fax
(815) 526-3467
NPI assigned
Jul 11, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 016005830 IL Primary
Foot & Ankle Surgery Podiatrist 213ES0103X 135.000921 IL

Addresses

Primary practice location

750 E Terra Cotta Ave Ste C
Crystal Lake, IL 60014

Mailing address

611 W. Park St.
Facp
Urbana, IL 61801

Other practice location 1

5666 E State St
Rockford, IL 61108-2425
Phone (815) 226-2000

Other practice location 2

1111 Trinity Ln
Bloomington, IL 61704-8111
Phone (309) 663-6461

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190514002708 IL Practitioner - Podiatry 7214224252 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians

Practice addresses (Care Compare)

2111 Midlands CT
Sycamore, IL 60178-3125
Phone (815) 758-0000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue70
Removal of skin lesions1-10
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
135.000921ILMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince Apr 1, 2024 Accepting new patients
Central Dupage Physician Group CurrentSince Apr 1, 2024 Accepting new patients
Carle West Physician Group Inc CurrentSince Aug 30, 2021 Accepting new patients

Locations

1111 Trinity Ln
Ste 111
Bloomington, IL 61704
Phone (309) 663-6461

2204 Eastland Dr
Bloomington, IL 61704
Phone (309) 662-9461

1111 Trinity Ln
Bloomington, IL 61704
Phone (309) 661-6414

Dept 5777
Carol Stream, IL 60122

Carol Stream, IL 60122
Phone (630) 933-3300

750 E Terra Cotta Ave
Ste C
Crystal Lake, IL 60014
Phone (815) 455-0800

750 E Terra Cotta Ave
Ste A
Crystal Lake, IL 60014
Phone (815) 455-1800

1310 N Main St
Ste 100
Sandwich, IL 60548
Phone (815) 758-0000

2111 Midlands Ct
Sycamore, IL 60178
Phone (815) 748-8900

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

Organizations & group practices 4

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 5

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": "1468195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1396197604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W. PARK ST.",
            "address_2": "FACP",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "61801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E TERRA COTTA AVE STE C",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "60014",
            "telephone_number": "847-639-5800",
            "fax_number": "815-526-3467"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5666 E State St",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611082425",
            "country_code": "US",
            "telephone_number": "815-226-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1111 Trinity Ln",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "IL",
            "postal_code": "617048111",
            "country_code": "US",
            "telephone_number": "309-663-6461",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUFFINGTON",
        "first_name": "ADAM",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-11",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016005830",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "135.000921",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

Verify at the official NPI Registry.