Individual provider Active NPI

Manji Belinda Osifeso, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Richfield, MN
National Provider Identifier
1033465505
Registry record updated Sep 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
60543 Issued in MN
Practice address
790 West 66TH Street
HCMC Richfield Clinic
Richfield, MN 55423
Phone
(612) 873-6963
NPI assigned
Aug 1, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X T6340 TX
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 35.125457 OH
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 60543 MN Primary

Addresses

Primary practice location

790 West 66TH Street
HCMC Richfield Clinic
Richfield, MN 55423

Mailing address

790 West 66TH Street
HCMC Richfield Clinic
Richfield, MN 55423
Phone (612) 873-6963

Other practice location 1

520 Douglas Blvd
Tyler, TX 75702-8307
Phone (903) 606-1721

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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 1

Enrollment IDStateProvider typePAC IDDetails
I20220923002323 TX Practitioner - Internal MedicinePractitioner - Geriatric Medicine 9830482314 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Christus Trinity Clinic TexasGroup PAC ID 3072426741, 1,540 clinicians

Practice addresses (Care Compare)

3201 S Loop
Palestine, TX 75801-6901

520 Douglas Blvd
Tyler, TX 75702-8307
Phone (903) 593-1721

5321 S FM
14 Christus Trinity Clinic
Holly Lake Ranch, TX 75765-4839
Phone (903) 769-2990

620 S Fleishel Ave
Christus Trinity Clinic
Tyler, TX 75701-2041
Phone (903) 606-4900

630 S Fleishel Ave
Tyler, TX 75701-2041
Phone (903) 606-5560

PO Box
Suite 846098
Dallas, TX 75284-6098

Hospital & facility affiliations

  • Enhabit Home Health Home health agency, Tyler, TX, CCN 459457
  • Christus Homecare Home health agency, Tyler, TX, CCN 743197
  • Christus Mother Frances Hospital Hospital, Tyler, TX, CCN 450102

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.125457OHMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Metrohealth System Current Accepting new patients
Christus Trinity Clinic Texas Internal Medicine CurrentSince Sep 23, 2022 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Sep 23, 2022 Accepting new patients

Locations

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

520 Douglas Blvd
Tyler, TX 75702
Phone (903) 510-1175

Interoperability endpoints

  • Direct secure messaging: mosifeso287224@christushealth.direct-ci.net
  • Direct secure messaging: mosifeso104135@direct.metrohealth.org

Organizations & group practices 3

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1343779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1033465505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 WEST 66TH STREET",
            "address_2": "HCMC RICHFIELD CLINIC",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "55423",
            "telephone_number": "612-873-6963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 WEST 66TH STREET",
            "address_2": "HCMC RICHFIELD CLINIC",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "55423",
            "telephone_number": "612-873-6963"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "520 Douglas Blvd",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757028307",
            "country_code": "US",
            "telephone_number": "903-606-1721",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OSIFESO",
        "first_name": "MANJI",
        "middle_name": "BELINDA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-01",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "T6340",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "OH",
            "license": "35.125457",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MN",
            "license": "60543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richfield, MN

Sources for this page

Verify at the official NPI Registry.