NPIMap

Organization Active NPI

Largo Foot & Ankle Health Center and Ambulatory Surgical Center,Inc'

  • Foot & Ankle Surgery Podiatrist
  • Upper Marlboro, MD
National Provider Identifier
1962596031
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
01264 Issued in MD
Legal business name
LARGO FOOT & ANKLE HEALTH CENTER AND AMBULATORY SURGICAL CENTER,INC'
Practice address
1450 Mercantile LN Ste 151
Upper Marlboro, MD 20774-5386
Phone
(301) 386-5453
Fax
(301) 386-5396
NPI assigned
Oct 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

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

Authorized official

Name
Dr. Ademuyiwa Adekola Adetunji, DPMNPI 1487638854
Title
President
Phone
(301) 386-5453

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X 01264 MD Primary

Addresses

Primary practice location

1450 Mercantile LN Ste 151
Upper Marlboro, MD 20774-5386

Mailing address

PO Box 265
Fulton, MD 20759-0265
Phone (301) 386-5453

Other identifiers 2

IdentifierTypeStateIssuer
035063500MedicaidDC
319906101MedicaidMD

Other names 1

  • Ade adetunji Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20081201000563 DC Part B Supplier - Clinic/Group Practice 2668408535 Receives reassigned benefits from 1 practitioner
Practice locations: Upper Marlboro, MD
O20100930040985 MD DME Supplier - Physician - Podiatry 2668408535 Practice locations: Largo, MD

National Provider Directory

National Provider Directory

Locations

1450 Mercantile Ln
Ste 151
Uppr Marlboro, MD 20774
Phone (301) 322-8014

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11195/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725408000000",
    "number": "1962596031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 265",
            "city": "FULTON",
            "state": "MD",
            "postal_code": "207590265",
            "telephone_number": "301-386-5453",
            "fax_number": "301-386-5396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 MERCANTILE LN STE 151",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207745386",
            "telephone_number": "301-386-5453",
            "fax_number": "301-386-5396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARGO FOOT & ANKLE HEALTH CENTER AND AMBULATORY SURGICAL CENTER,INC'",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A",
        "authorized_official_last_name": "ADETUNJI",
        "authorized_official_first_name": "ADEMUYIWA",
        "authorized_official_middle_name": "ADEKOLA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-386-5453",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MD",
            "license": "01264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "035063500",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "319906101",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ade adetunji",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Upper Marlboro, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.