Individual provider Active NPI

Lincoln Olalekan Adeyemi, PA

  • Physician Assistant
  • Jamaica, NY
National Provider Identifier
1649378399
Registry record updated Aug 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
010990 Issued in NY
Practice address
82-68 164TH St
Jamaica, NY 11432-1121
Phone
(718) 883-3225
Fax
(718) 883-6193
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 010990 NY Primary

Addresses

Primary practice location

82-68 164TH St
Jamaica, NY 11432-1121

Mailing address

506 Lenox Avenue
New York, NY 10037
Phone (718) 873-7195

Other identifiers 1

IdentifierTypeStateIssuer
00246075MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071017000195 NY Practitioner - Physician Assistant 9638265036 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore Lij Urgent Care PCGroup PAC ID 6002131778, 389 clinicians

Practice addresses (Care Compare)

125 Greaves LN
Staten Island, NY 10308-2175
Phone (718) 502-8763

1445 Richmond Ave
Staten Island, NY 10314-1563
Phone (929) 219-0622

1555 1St Ave
New York, NY 10028-3903
Phone (212) 897-1991

1700 Hylan Blvd
Staten Island, NY 10305-1930
Phone (516) 537-9062

199 Amsterdam Ave
New York, NY 10023-5024
Phone (646) 863-0463

2590 Hylan Blvd
Unit a
Staten Island, NY 10306-4368
Phone (718) 502-9879

28 -30 Triangle Ctr
Yorktown Heights, NY 10598-4104
Phone (914) 266-3103

2935 Veterans Rd W
Suite B
Staten Island, NY 10309-2514
Phone (347) 705-7121

30 Hamilton St
Dobbs Ferry, NY 10522-2862
Phone (914) 202-2944

377 S Oyster Bay Rd
Plainview, NY 11803-3323
Phone (516) 537-9061

41 E 8TH St
New York, NY 10003-6450
Phone (212) 897-1991

4316 Amboy Rd
Staten Island, NY 10312-3820
Phone (929) 282-4146

5828 99TH St
Corona, NY 11368-4306
Phone (718) 502-9867

5828 99TH St Corona
Corona, NY 11368-4306
Phone (718) 502-9867

595 Hempstead Tpke
Suite a
West Hempstead, NY 11552-1030
Phone (347) 493-2952

650 White Plains Rd
Tarrytown, NY 10591-5104
Phone (914) 266-3102

77 Quaker Ridge Rd
Suite 4
New Rochelle, NY 10804-2812
Phone (914) 266-3104

9881 Queens Blvd
Rego Park, NY 11374-4404
Phone (718) 502-9798

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
010990NYMDOccupational Therapist

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: lincoln.adeyemi@ghuc.eclinicaldirectplus.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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186617600000",
    "number": "1649378399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 LENOX AVENUE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10037",
            "telephone_number": "718-873-7195",
            "fax_number": "212-939-8409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82-68 164TH ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114321121",
            "telephone_number": "718-883-3225",
            "fax_number": "718-883-6193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADEYEMI",
        "first_name": "LINCOLN",
        "middle_name": "OLALEKAN",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "010990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00246075",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica, NY

Sources for this page

Verify at the official NPI Registry.