NPIMap

Individual provider Active NPI

Abiel Koffi Madje Adjagodo, PA-C

  • Physician Assistant
  • Saint Paul, MN
National Provider Identifier
1760150692
Registry record updated Jun 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
14697 Issued in MN
Practice address
895 7TH St E
Saint Paul, MN 55106-3871
Phone
(763) 377-5545
Fax
(651) 602-7513
NPI assigned
Sep 3, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2024

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 14697 MN Primary

Addresses

Primary practice location

895 7TH St E
Saint Paul, MN 55106-3871

Mailing address

3297 235TH Ave NW
Saint Francis, MN 55070-9630
Phone (763) 377-5545

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20240404002764 MN Practitioner - Physician Assistant 5395183735 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Side Community Health Services, Inc.Group PAC ID 2062306434, 51 clinicians

Practice addresses (Care Compare)

153 Cesar Chavez St
Saint Paul, MN 55107-2226
Phone (651) 602-7500

895 7TH St E
Saint Paul, MN 55106-3871
Phone (651) 602-7500

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
14697MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
West Side Community Health Services, Inc. CurrentSince Jan 17, 2024 Accepting new patients
West Side Community Health Services, Inc. CurrentSince Jan 17, 2024 Accepting new patients

Locations

895 7th St E
Saint Paul, MN 55106
Phone (651) 793-2250

153 Cesar Chavez St
West Saint Paul, MN 55107
Phone (651) 222-1816

Interoperability endpoints

  • Direct secure messaging: aadjagodo732984@direct.ochin.org

Organizations & group practices 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1630627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718582400000",
    "number": "1760150692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3297 235TH AVE NW",
            "city": "SAINT FRANCIS",
            "state": "MN",
            "postal_code": "550709630",
            "telephone_number": "763-377-5545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "895 7TH ST E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551063871",
            "telephone_number": "763-377-5545",
            "fax_number": "651-602-7513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADJAGODO",
        "first_name": "ABIEL",
        "middle_name": "KOFFI MADJE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-03",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.