Individual provider Active NPI

Adae Opoku Amoako, M.D.

  • Family Medicine Physician
  • Bloomsburg, PA
National Provider Identifier
1710253141
Registry record updated Aug 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD455322 Issued in PA
Practice address
240 Mall Blvd
Bloomsburg, PA 17815-8306
Phone
(570) 784-8303
Fax
(570) 387-5030
NPI assigned
Mar 29, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2026

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 MD455322 PA Primary

Addresses

Primary practice location

240 Mall Blvd
Bloomsburg, PA 17815-8306

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 784-8303

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, GA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160921000886 DC Practitioner - Family Practice 2961799895 Reassigns benefits to 1 organization
I20220120000564 GA Practitioner - Family Practice 2961799895 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kaiser Foundation Health Plan of the Mid Atlantic States, IncGroup PAC ID 3779495858, 1,921 clinicians
The Southeast Permanente Medical GroupGroup PAC ID 6204829013, 823 clinicians

Practice addresses (Care Compare)

1221 Mercantile LN
Largo, MD 20774-5374
Phone (301) 618-5700

3495 Piedmont Rd NE
Atlanta, GA 30305-1729
Phone (404) 364-7206

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD044533DCMDFamily Medicine Physician
0101261068VAMDFamily Medicine Physician
D0082083MDMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Southeast Permanente Medical Group Family Medicine CurrentSince Dec 12, 2021 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Aug 3, 2016 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc Family Medicine Current Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Aug 3, 2016 Accepting new patients

Locations

3495 Piedmont Rd NE
Bldg 9
Atlanta, GA 30305
Phone (404) 364-7000

655 Watkins Mill Rd
Montgomery Village, MD 20879
Phone (301) 929-7100

2101 E Jefferson St
Ste 6
Rockville, MD 20852

1221 Mercantile Ln
Upper Marlboro, MD 20774
Phone (301) 618-5500

100 N Academy Ave
Danville, PA 17822

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.

NPI Registry JSON

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

{
    "created_epoch": "1332979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786060800000",
    "number": "1710253141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-784-8303",
            "fax_number": "570-387-5030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 MALL BLVD",
            "city": "BLOOMSBURG",
            "state": "PA",
            "postal_code": "178158306",
            "telephone_number": "570-784-8303",
            "fax_number": "570-387-5030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMOAKO",
        "first_name": "ADAE",
        "middle_name": "OPOKU",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-29",
        "last_updated": "2026-08-07",
        "certification_date": "2026-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD455322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "655 Watkins Mill Rd",
            "city": "Gaithersburg",
            "state": "MD",
            "country_code": "US",
            "postal_code": "208793301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bloomsburg, PA

Sources for this page

Verify at the official NPI Registry.