SAMUEL O FADARE, MD, PC
NPI 1639287824
Clinic/Center - Adult Mental Health in Gladstone, MO
About Samuel O Fadare, Md, Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SAMUEL O FADARE, MD, PC (NPI 1639287824) is a healthcare organization registered as an adult mental health in Gladstone, Missouri and active in the NPI registry since August 2006. The organization lists Samuel O Fadare, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Samuel O Fadare, Md, Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Samuel O Fadare, MD, PC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Samuel O Fadare, MD, PA's NPI number?
The NPI number for Samuel O Fadare, MD, PA is 1639287824. It was assigned to this organization in the NPPES registry on August 28, 2006. The provider is doing business as Samuel O Fadare, MD, PC.
Where is Samuel O Fadare, MD, PA located?
Samuel O Fadare, MD, PA is located at 5604 NE Antioch Rd, Gladstone, MO 64119. The listed phone number is (660) 372-1313.
What is Samuel O Fadare, MD, PA's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Adult Mental Health, with taxonomy code 261QM0850X.
Is Samuel O Fadare, MD, PA enrolled in Medicare?
Yes. Samuel O Fadare, MD, PA is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Samuel O Fadare, MD, PA?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Samuel O Fadare, MD, PA, in Nurse Practitioner and Psychiatry. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Samuel O Fadare, MD, PA was last updated on December 8, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Samuel O Fadare, Md, Pc · NPI 1639287824
Adult Mental Health organization in Gladstone, Missouri. Organization record, active in the CMS NPPES registry since August 28, 2006.
## Identity
- **NPI:** 1639287824 (Entity type: Organization)
- **Enumerated:** August 28, 2006
- **Primary specialty:** Clinic/Center - Adult Mental Health · taxonomy 261QM0850X
- **Legal business name:** Samuel O Fadare, Md, Pa
- **Organization subpart:** No
- **Authorized official:** Samuel Fadare, OWNER
## Practice location
- **Address:** 5604 NE ANTIOCH RD, Gladstone, MO 64119-2327
- **Phone:** (660) 372-1313 · **Fax:** (660) 372-1339
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (1), Psychiatry (1); 2 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 8, 2020
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Source: [NPI Profile](https://npiprofile.com/npi/1639287824) · Data from the CMS NPPES public registry.