Waterfalls Medical Practice, P.C

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

053629 Issued in GA

Legal business name

WATERFALLS MEDICAL PRACTICE, P.C

Practice address

112 Governors SQ Ste B
Peachtree City, GA 30269-4864

Phone

(678) 932-8112

Fax

(678) 932-8113

NPI assigned

Jun 5, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Irene Ayoyinka Omotoso, MDNPI 1205848785

Title

Medical Director

Phone

(678) 932-8112

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/15952/brand/1/csg/1/fhir/r4

Practitioners 1

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

• Irene A Omotoso, MD

  • Internal Medicine Physician
  • Peachtree City, GA
  • NPI 1205848785
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1496620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592265600000",
    "number": "1225567225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 TOLMOUNT CT",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302693348",
            "telephone_number": "678-932-8112",
            "fax_number": "678-932-8113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 GOVERNORS SQ STE B",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302694864",
            "telephone_number": "678-932-8112",
            "fax_number": "678-932-8113"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1202 Tolmount Ct",
            "address_purpose": "LOCATION",
            "city": "Peachtree City",
            "state": "GA",
            "postal_code": "302693348",
            "country_code": "US",
            "telephone_number": "678-932-8112",
            "fax_number": "678-932-8113",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WATERFALLS MEDICAL PRACTICE, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-05",
        "last_updated": "2020-06-16",
        "certification_date": "2020-06-16",
        "status": "A",
        "authorized_official_last_name": "OMOTOSO",
        "authorized_official_first_name": "IRENE",
        "authorized_official_middle_name": "AYOYINKA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "678-932-8112",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "053629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Peachtree City, GA
• Providers in Peachtree City, 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 16, 2020; 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.