Kibibi Wanzu

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

POD001378 Issued in GA

Practice address

366 Racetrack Rd
McDonough, GA 30252-1022

Phone

(470) 781-5585

Fax

(470) 781-5586

NPI assigned

Sep 24, 2015

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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Temple University School of Medicine, 2015

Medicare assignment

May accept Medicare assignment

Group practices

Heartstride Health LLCGroup PAC ID 7315443314, 8 clinicians

Modern Podiatry, LLCGroup PAC ID 0345670980, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/GIGFDD/Endpoint/GIGFDD
• Direct secure messaging: kibibi.wanzu.p2@direct.360care.nextgenshare.com
• Direct secure messaging: kibibi.wanzu.1@20810.direct.athenahealth.com
• Direct secure messaging: kibibi.wanzu.2@20810.direct.athenahealth.com
• Direct secure messaging: kibibi.wanzu.p3@direct.360care.nextgenshare.com

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.

• Modern Podiatry, LLC

  • Podiatric Clinic/Center
  • McDonough, GA
  • NPI 1811538390
  Medicare reassignment Care Compare group NPD Authorized official
• Heartstride Health LLC

  • Interventional Cardiology Physician
  • Newnan, GA
  • NPI 1013888973
  Medicare reassignment Care Compare group
• Inspire Wellness & Aesthetics, LLC

  • Integrative Medicine Physician
  • Atlanta, GA
  • NPI 1578397543
  NPD Authorized official
• Limbs Preservation Institute

  • Podiatric Clinic/Center
  • Newnan, GA
  • NPI 1033935937
  NPD Authorized official
• Modern Podiatry, LLC

  • Podiatric Clinic/Center
  • Griffin, GA
  • NPI 1346070141

  Podiatrist

  NPD (past) Authorized official
• Modern Podiatry, LLC

  • Podiatric Clinic/Center
  • Newnan, GA
  • NPI 1871323683
  NPD (past) Authorized official
• Ronald D Patrick MD LLC

  • Surgery Physician
  • McDonough, GA
  • NPI 1053649608
  NPD (past)

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

{
    "created_epoch": "1443052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1043689623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "366 RACETRACK RD",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302521022",
            "telephone_number": "470-781-5585",
            "fax_number": "470-781-5586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "366 RACETRACK RD",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302521022",
            "telephone_number": "470-781-5585",
            "fax_number": "470-781-5586"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "730 S 8th St",
            "address_purpose": "LOCATION",
            "city": "Griffin",
            "state": "GA",
            "postal_code": "302244827",
            "country_code": "US",
            "telephone_number": "770-228-6644",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANZU",
        "first_name": "KIBIBI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-24",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "GA",
            "license": "POD001378",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "GA",
            "license": "POD001378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "14312441",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003207314G",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003207314",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walnut Creek Family Practice, P.C.
• Zeke Orazi Walsh
• Abigail Lilla Walters
• Sophia Walters, LICENSED OPTICIAN
• Patricia A Waltower, RN MSHS
• Rebecca Ward
• Stephen L. Ware Jr.
• Warm Hearts Rides LLC
• Clara Nicole Warren, MA, LPC, NCC
• Rayonna Warren, MEDICAL ASSISTANT

• Foot & Ankle Surgery Podiatrist in McDonough, GA
• Providers in McDonough, GA by specialty
• Foot & Ankle Surgery Podiatrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; 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.