Egede J Aitsebaomo, MD
Individual provider Active NPI Cardiovascular Disease Physician · Sayre, PA
NPI 1376620682 · NPPES record last updated Mar 14, 2021
Key facts
- NPI
- 1376620682
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- License
- MD459847 (PA)
- Practice address
- 1 Guthrie SQ
Sayre, PA 18840-1625 - Phone
- (570) 887-2289
- Fax
- (570) 887-2290
- NPI assigned
- Nov 1, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Cardiovascular Disease (Cardiology)
- Education
- University of Texas Medical School at Houston, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Guthrie Medical Group PC
Practice addresses (Care Compare)
1 Guthrie SQ
Sayre, PA 18840-1625
Phone (570) 887-3192
31 Arnot Rd
A
Horseheads, NY 14845-8533
Phone (607) 795-5100
Hospital & facility affiliations
- Robert Packer Hospital
- Corning Hospital
- Guthrie Cortland Regional Medical Center
- Troy Community Hospital
- Our Lady of Lourdes Memorial Hospital, Inc
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in PA, NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170307000697 | PA | Practitioner - Cardiovascular Disease (Cardiology) | 4880618552 | Reassigns benefits to 1 organization |
| I20181109001257 | NY | Practitioner - Cardiovascular Disease (Cardiology) | 4880618552 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD459847 | PA | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Guthrie Medical Group, P.C. | Current | Accepting new patients | |
| Guthrie Medical Group, P.C. | Current | Accepting new patients | |
| Guthrie Medical Group, P.C. | Cardiovascular Disease | Current |
Accepting new patients |
| Guthrie Medical Group, P.C. | Current |
Accepting new patients | |
| Guthrie Medical Group, P.C. | Cardiovascular Disease | Current |
Accepting new patients |
| University of North Carolina at Chapel Hill | Past | Accepting new patients | |
| Louisburg Hospitalists, PLLC | Past | Accepting new patients | |
| Robert Packer Hospital | Past | Accepting new patients |
Locations
130 Center Way
Corning, NY 14830
Phone (607) 936-9971
31 Arnot Rd
#A
Horseheads, NY 14845
Phone (607) 739-3874
1 Guthrie Sq
Sayre, PA 18840
Phone (570) 887-3106
285 Guthrie Dr
Troy, PA 16947
Phone (570) 297-4104
Interoperability endpoints
- eaitsebaomo106498@direct-guthrie.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 285781 | NY | |
| Cardiovascular Disease Physician | 207RC0000X | MD459847 | PA | Yes |
Addresses
Primary practice location
1 Guthrie SQ
Sayre, PA 18840-1625
Mailing address
1 Guthrie SQ
Sayre, PA 18840-1625
Phone (570) 888-5858
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8913023 | Medicaid | NC |
Other providers in Sayre, PA
- Akriti Agrawal
- Vineet Agrawal
- Cristina Aguilar
- Katie Ahart
- Ahmed Clinic
- Shamima Akhter
- Muhammad Sarmad Aleem
- Sneha Rachel Alexander
- Kathleen Mae Palma Alfonso
- Didier Olivier Alipui
All providers in Sayre, PA · Cardiovascular Disease Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.