Individual provider Active NPI

Miriam Moses Onyegbula, MD

  • Family Medicine Physician
  • Conyers, GA
National Provider Identifier
1306462619
Registry record updated Oct 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11689 Issued in GA
Practice address
1910 Highway 20 SE Ste 270
Conyers, GA 30013-2082
Phone
(770) 922-3522
Fax
(404) 367-6980
NPI assigned
Jun 23, 2020
Last updated
Oct 24, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 11689 GA Primary

Addresses

Primary practice location

1910 Highway 20 SE Ste 270
Conyers, GA 30013-2082

Mailing address

1910 Highway 20 SE Ste 270
Conyers, GA 30013-2082
Phone (770) 922-3522

Other practice location 1

2336 Dawson Rd Ste 2200
Albany, GA 31707-2801
Phone (229) 312-8797

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20230807001874 GA Practitioner - Family Practice 3678934692 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Piedmont Medical Care CorporationGroup PAC ID 6002802220, 368 clinicians

Practice addresses (Care Compare)

1910 Hwy 20 SE
Suite 270
Conyers, GA 30013-2082
Phone (678) 413-4380

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.62 of 100Reported as apm
Quality
83.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11689GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Medical Care Corporation Family Medicine CurrentSince Sep 11, 2023 Accepting new patients
Piedmont Providers LLC Past Accepting new patients
Phoebe Putney Memorial Hospital Family Medicine PastSince Jun 1, 2020 Accepting new patients

Locations

105 Collier Rd NW
Ste 5020
Atlanta, GA 30309
Phone (404) 350-3860

1910 Highway 20 SE
Ste 270
Conyers, GA 30013
Phone (770) 761-0501

Organizations & group practices 4

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.

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": "1592870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698105600000",
    "number": "1306462619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 HIGHWAY 20 SE STE 270",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300132082",
            "telephone_number": "770-922-3522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 HIGHWAY 20 SE STE 270",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300132082",
            "telephone_number": "770-922-3522",
            "fax_number": "404-367-6980"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2336 Dawson Rd Ste 2200",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "GA",
            "postal_code": "317072801",
            "country_code": "US",
            "telephone_number": "229-312-8797",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ONYEGBULA",
        "first_name": "MIRIAM",
        "middle_name": "MOSES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-23",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "11689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

Verify at the official NPI Registry.