Adeyemi Christanah Adeniyi, A-GNP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

RN2310738 Issued in MA

Practice address

45 Dimock St
Roxbury, MA 02119-1208

Phone

(617) 442-8800

Fax

(617) 541-8472

NPI assigned

Jul 30, 2019

Last updated

Aug 22, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

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

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dimock Community Health Center, Inc.Group PAC ID 7012810492, 43 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Beth Israel Deaconess Medical Center Hospital, Boston, MA, CCN 220086

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Dimock Community Health Center, Inc

  dba The Dimock Center

  • Federally Qualified Health Center (FQHC)
  • Roxbury, MA
  • NPI 1588719488
  Medicare reassignment Care Compare group NPD
• Dimock Community Health Center, Inc

  dba Dimock Pharmacy

  • Community/Retail Pharmacy
  • Roxbury, MA
  • NPI 1023850120
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Beth Israel Deaconess Medical Center, Inc.

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1548202641
  Care Compare affiliation

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

{
    "created_epoch": "1564444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661126400000",
    "number": "1780238659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 W BLACKWELL ST",
            "city": "DOVER",
            "state": "NJ",
            "postal_code": "078013841",
            "telephone_number": "973-328-3344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 DIMOCK ST",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021191208",
            "telephone_number": "617-442-8800",
            "fax_number": "617-541-8472"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18 W Blackwell St",
            "address_purpose": "LOCATION",
            "city": "Dover",
            "state": "NJ",
            "postal_code": "078013841",
            "country_code": "US",
            "telephone_number": "973-328-3344",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADENIYI",
        "first_name": "ADEYEMI",
        "middle_name": "CHRISTANAH",
        "credential": "A-GNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-30",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "AG07190264",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MA",
            "license": "RN2310738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Asha Ahmed Abdullahi
• Giovanni Acevedo
• Claritza Acosta
• Lucresia Adams
• Safina Adatia, MD
• Tamara Adrien
• Ruchir Agarwal, DDS
• Austin Agbonifo
• Maria Agit
• Oscar David Agudelo

• Primary Care Nurse Practitioner in Roxbury, MA
• Providers in Roxbury, MA by specialty
• Primary Care Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; 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.