Amarachukwu Imediegwu Osisanya, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

073964 Issued in GA

Practice address

1255 Highway 54 W
Fayetteville, GA 30214-4526

Phone

(770) 719-6911

NPI assigned

Apr 4, 2012

Last updated

Feb 6, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Amarachukwu Imediegwu Osisanya Other name

Electronic endpoints 1

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Southeast Permanente Medical GroupGroup PAC ID 6204829013, 823 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956
  Medicare reassignment Care Compare group NPD
• Emerginet Henry, LLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Atlanta, GA
  • NPI 1811946627
  Medicare reassignment NPD
• Emerginet SRMC, LLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Atlanta, GA
  • NPI 1538118344
  Medicare reassignment NPD

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

{
    "created_epoch": "1333497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644105600000",
    "number": "1275899106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1255 HIGHWAY 54 W",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144526",
            "telephone_number": "770-719-6911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 HIGHWAY 54 W",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144526",
            "telephone_number": "770-719-6911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSISANYA",
        "first_name": "AMARACHUKWU",
        "middle_name": "IMEDIEGWU",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-04",
        "last_updated": "2022-02-06",
        "certification_date": "2022-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "073964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "750 Townpark Ln NW",
            "city": "Kennesaw",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301445579",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AMARACHUKWU",
            "last_name": "OSISANYA",
            "middle_name": "IMEDIEGWU",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Esohe Osaghae, MSN, RN-BC, CCM
• Ajala Osagie, M.D.
• Sarah Grace Osborne, OT
• William Osborne, M.D.
• Mandy G Osburn, MPT
• Catherine K Osuagwu, APRN
• Omolola Otubaga, NP
• Rebecca Carolyn Otwell-Dove, PHD
• Lauryn Overstreet, LCSW-C
• Owens Counseling Services, LLC

• Emergency Medicine Physician in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Emergency Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2022; 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.