NPIMap

Individual provider Active NPI

Adetutu Basirat Adetona, M.D.

  • Family Medicine Physician
  • Troy, NY
National Provider Identifier
1629038930
Registry record updated Jan 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
205662-1 Issued in NY
Practice address
595 5TH Ave
Troy, NY 12182-2501
Phone
(518) 235-8034
Fax
(518) 235-8036
NPI assigned
Mar 23, 2006
Last updated
Jan 30, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 205662-1 NY Primary

Addresses

Primary practice location

595 5TH Ave
Troy, NY 12182-2501

Mailing address

595 5TH Ave
Troy, NY 12182-2501
Phone (518) 235-8034

Other identifiers 1

IdentifierTypeStateIssuer
01746818MedicaidNY

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
I20040518001147 NY Practitioner - Family Practice 2365432747 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lansingburgh Family Practice PCGroup PAC ID 8224028691, 3 clinicians

Practice addresses (Care Compare)

595 5TH Ave
Troy, NY 12182-2501
Phone (518) 235-8034

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy11

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
205662-1NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lansingburgh Family Practice, PC Family Medicine CurrentSince Apr 1, 2004 Accepting new patients
Schenectady County Past Accepting new patients
CLR Troy LLC Past Accepting new patients

Locations

595 5th Ave
Troy, NY 12182
Phone (518) 235-8034

Interoperability endpoints

  • FHIR API: https://fhir.medent.com/fhir/R4/gwT5767X

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
Riverside Center for Rehabilitation and NursingCastleton, NY, CCN 335525 Skilled nursing facility Contracted Managing Employee Apr 1, 2022

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 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 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": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580342400000",
    "number": "1629038930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 5TH AVE",
            "city": "TROY",
            "state": "NY",
            "postal_code": "121822501",
            "telephone_number": "518-235-8034",
            "fax_number": "518-235-8036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "595 5TH AVE",
            "city": "TROY",
            "state": "NY",
            "postal_code": "121822501",
            "telephone_number": "518-235-8034",
            "fax_number": "518-235-8036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADETONA",
        "first_name": "ADETUTU",
        "middle_name": "BASIRAT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-23",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "205662-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01746818",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, NY

Sources for this page

Verify at the official NPI Registry.