Charles Godfried Otu-Nyarko, M.D

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

License

MD.203819 Issued in LA

Practice address

2508 Bert Kouns Loop
Suite 101
Shreveport, LA 71118-3133

Phone

(318) 212-5858

Fax

(318) 212-5877

NPI assigned

Aug 19, 2008

Sex

Male

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 1

Medicare fee-for-service enrollment

Enrolled in LA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cotuny@direct.wkhs.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.

• Ochsner Clinic LLC

  • General Practice Physician
  • New Orleans, LA
  • NPI 1538151428
  Medicare reassignment NPD
• WK Center for Pediatric Gastroenterology

  • Pediatric Gastroenterology Physician
  • Shreveport, LA
  • NPI 1720620784
  Medicare reassignment NPD
• Ochsner Clinic LLC

  • Registered Dietitian
  • Covington, LA
  • NPI 1013747039
  NPD
• Ochsner Clinic LLC

  • General Practice Physician
  • Jefferson, LA
  • NPI 1760668537
  NPD

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

{
    "created_epoch": "1219104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620950400000",
    "number": "1245487404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS LOOP",
            "address_2": "SUITE 101",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183133",
            "telephone_number": "318-212-5858",
            "fax_number": "318-212-5877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS LOOP",
            "address_2": "SUITE 101",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183133",
            "telephone_number": "318-212-5858",
            "fax_number": "318-212-5877"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8200 Constantin Blvd Fl 4",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "708093481",
            "country_code": "US",
            "telephone_number": "225-765-5500",
            "fax_number": "225-765-2054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OTU-NYARKO",
        "first_name": "CHARLES",
        "middle_name": "GODFRIED",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-19",
        "last_updated": "2021-05-14",
        "certification_date": "2021-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "125.052705",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "LA",
            "license": "MD.203819",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2107259",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madeline Osborn, PT
• Esther Yvonne Osborne, LCSW
• Bismarck Gitenyi Osumo, M.D.
• Lydia Barham Oswalt
• D'Juna A Otis
• Laura Ourso
• Jeffrey T Overdyke, MD
• William L Overdyke, MD
• Overton Brooks VA
• Overton Brooks VA Hospital

• Pediatric Gastroenterology Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Pediatric Gastroenterology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.