Individual provider Active NPI

Thomas Obisesan, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Washington, DC
National Provider Identifier
1295894426
Registry record updated Nov 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
MD19950 Issued in DC
Practice address
2041 Georgia Ave NW
Washington, DC 20060-0001
Phone
(202) 865-3290
Fax
(202) 865-3833
NPI assigned
Dec 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X MD19950 DC Primary

Addresses

Primary practice location

2041 Georgia Ave NW
Washington, DC 20060-0001

Mailing address

2041 Georgia Ave NW Tower 6101
Washington, DC 20060-0001

Other identifiers 3

IdentifierTypeStateIssuer
758141601MedicaidMD
010015413MedicaidVA
023971400MedicaidDC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
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

Enrollment IDStateProvider typePAC IDDetails
I20040224000142 DC Practitioner - Geriatric MedicinePractitioner - Family Practice 0749176139 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric Medicine
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Howard UniversityGroup PAC ID 0941109565, 182 clinicians

Practice addresses (Care Compare)

2041 Georgia NW Ave
Washington, DC 20060-0001
Phone (202) 865-6679

Hospital & facility affiliations

  • Howard University Hospital Corp Hospital, Washington, DC, CCN 090003
  • Washington Ctr for Aging SVCS Nursing home, Washington, DC, CCN 095014

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD19950DCMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Howard University CurrentSince Jan 1, 2014 Accepting new patients
Stoddard Baptist Global Care Past Accepting new patients

Locations

2139 Georgia Ave NW
Washington, DC 20001
Phone (202) 865-1121

4414 Benning Rd NE
Fl 2
Washington, DC 20019
Phone (202) 865-2120

2041 Georgia Ave NW
#6101
Washington, DC 20060

2041 Georgia Ave NW
Washington, DC 20060
Phone (202) 865-3785

2101 Medical Park Dr
Ste 305
Silver Spring, MD 20902
Phone (301) 754-0833

Interoperability endpoints

  • Direct secure messaging: thomasobisesan@hufp.allscriptsdirect.net

Organizations & group practices 2

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574380800000",
    "number": "1295894426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2041 GEORGIA AVE NW TOWER 6101",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200600001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2041 GEORGIA AVE NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200600001",
            "telephone_number": "202-865-3290",
            "fax_number": "202-865-3833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBISESAN",
        "first_name": "THOMAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-06",
        "last_updated": "2019-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "DC",
            "license": "MD19950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "758141601",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010015413",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023971400",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

Verify at the official NPI Registry.