Obinna I Maduka, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

037518 Issued in CT

Practice address

387 Tuckie Rd Ste C
North Windham, CT 06256-1355

Phone

(860) 456-1279

Fax

(860) 456-1298

NPI assigned

Nov 2, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Obinna Maduka Former name

Medicare fee-for-service enrollment

Enrolled in CT

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

Specialty

Pediatric Medicine

Education

Other, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prohealth Physicians PCGroup PAC ID 1355246950, 214 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: obinna.maduka.npi1710065917.phpct@direct.optumcare.masshiway.net

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.

• Prohealth Physicians PC

  • Family Medicine Physician
  • Farmington, CT
  • NPI 1720194053

  Pediatrics

  Medicare reassignment Care Compare group NPD
• Windham Primary Care LLC

  • Pediatric Adolescent Medicine Physician
  • North Windham, CT
  • NPI 1780874776
  NPD (past) Authorized official
• Mansfield Pediatrics LLC

  • Pediatrics Physician
  • Mansfield Center, CT
  • NPI 1285729780
  NPD (past)

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710065917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "387 TUCKIE RD STE C",
            "city": "NORTH WINDHAM",
            "state": "CT",
            "postal_code": "062561355",
            "telephone_number": "860-456-1279",
            "fax_number": "860-456-1298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "387 TUCKIE RD STE C",
            "city": "NORTH WINDHAM",
            "state": "CT",
            "postal_code": "062561355",
            "telephone_number": "860-456-1279",
            "fax_number": "860-456-1298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADUKA",
        "first_name": "OBINNA",
        "middle_name": "I",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "037518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001375189",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "OBINNA",
            "last_name": "MADUKA",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Robert F Dubois, DC
• East Coast Behavioral Health LLC
• Evidence Based Services LLC Connecticut Division
• Brandi Hernandez/ L Hernandez
• Alexandra Jane Joy, LPC, ATR-BC
• Kristen Lara Magnuson, RPH
• Masseeh Niazi
• North Windham Eye Care, P.C.
• Partners in Counseling LLC
• Kara Puglisi

• Pediatrics Physician in North Windham, CT
• Providers in North Windham, CT by specialty
• Pediatrics Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.