Providence Medical Group, PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

051703 Issued in GA

Legal business name

PROVIDENCE MEDICAL GROUP, PC

Practice address

550 Peachtree St NE
Suite 1285
Atlanta, GA 30308-2249

Phone

(404) 856-3213

Fax

(404) 856-3217

NPI assigned

Dec 5, 2006

Last updated

Jun 19, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Oladayo Adisa Osinuga, MDNPI 1396716312

Title

President

Phone

(404) 684-7111

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations (25 of 40)

Practitioners 68

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Oladayo Adisa Osinuga, MD

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1396716312
  Medicare reassignment NPD Authorized official
• Adetokunboh Monsurundeen Adebayo, MD

  • Internal Medicine Physician
  • Decatur, GA
  • NPI 1689645699
  NPD (past)
• Barbara Jenetha Keels Andrews, NP

  • Family Nurse Practitioner
  • Atlanta, GA
  • NPI 1184655961
  NPD (past)
• Traci A Ackron, D.O.

  • Family Medicine Physician
  • Hillsboro, OR
  • NPI 1336588789
  NPD (past)
• Gabrielle Simone Alexander, M.D

  • Obstetrics & Gynecology Physician
  • Portland, OR
  • NPI 1124480413
  NPD (past)
• Amy Marie Anderson, PA-C

  • Physician Assistant
  • Hillsboro, OR
  • NPI 1235653288
  NPD (past)
• Rebecca Ann Anthony, MD

  • Psychiatry Physician
  • Portland, OR
  • NPI 1467945006
  NPD (past)
• Brandon E Bartlett, MD

  • Family Medicine Physician
  • Hillsboro, OR
  • NPI 1306580931
  NPD (past)
• Mary Elyse Beckman, LPC

  • Professional Counselor
  • Portland, OR
  • NPI 1851659759
  NPD (past)
• Anca-Maria Bejenaru, MD

  • Psychiatry Physician
  • Portland, OR
  • NPI 1861999807
  NPD (past)
• Alexandra Gabrielle Bond, M.D.

  • Family Medicine Physician
  • Beaverton, OR
  • NPI 1427497031
  NPD (past)
• Jeffrey Reed Carlson II, DO

  • Psychiatry Physician
  • Oregon City, OR
  • NPI 1508842584
  NPD (past)

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340064000000",
    "number": "1063570604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4047",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312084047",
            "telephone_number": "404-856-3213",
            "fax_number": "404-856-3217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 PEACHTREE ST NE",
            "address_2": "SUITE 1285",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303082249",
            "telephone_number": "404-856-3213",
            "fax_number": "404-856-3217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE MEDICAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2012-06-19",
        "status": "A",
        "authorized_official_last_name": "OSINUGA",
        "authorized_official_first_name": "OLADAYO",
        "authorized_official_middle_name": "ADISA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-684-7111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "051703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Providence Foot & Ankle Centers, P.C. Inc.
• Providence Foot & Ankle Centers, PC Inc
• Providence Healthcare
• Providence Healthcare Services, Inc (Boston Healthcare Alliance)
• Providence Home Care LLC
• Providence Transportation LLC
• Cathleen Ann Provins, RN, ACNP-BC, PHD
• Provost Eye Group, P.C.
• Michael Provost, DC
• Kristina Prox, RDN, LD

• Internal Medicine Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2012; 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.