Modupeola Brisibe

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN192902 Issued in GA

Practice address

280 Cobb Pkwy S Ste 60
Marietta, GA 30060-6531

Phone

(888) 663-6331

Fax

(415) 252-7176

NPI assigned

Jun 19, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Iora Health Georgia PCGroup PAC ID 1850644394, 27 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wellstar Cobb Medical Center Hospital, Austell, GA, CCN 110143
• Wellstar Douglas Medical Center Hospital, Douglasville, GA, CCN 110184
• Wellstar Kennestone Regional Medical Center Hospital, Marietta, GA, CCN 110035

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

State licenses

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 and National Provider Directory roles.

• Iora Health Georgia, P.C.

  • Internal Medicine Physician
  • Tucker, GA
  • NPI 1457846727
  Medicare reassignment Care Compare group NPD
• Iora Senior Health, LLC

  • Internal Medicine Physician
  • Tucker, GA
  • NPI 1518446194
  Medicare reassignment NPD
• Iora Health Georgia, P.C.

  • Internal Medicine Physician
  • Marietta, GA
  • NPI 1184283772
  NPD
• Iora Health Georgia, P.C.

  • Internal Medicine Physician
  • Decatur, GA
  • NPI 1205326881
  NPD
• Iora Senior Health, LLC

  • Internal Medicine Physician
  • Marietta, GA
  • NPI 1104485788
  NPD
• Iora Senior Health, LLC

  • Internal Medicine Physician
  • Arvada, CO
  • NPI 1760867428
  NPD
• Qcpi-Villagemd, PC

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1558872432
  NPD (past)

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

• Cobb Hospital, Inc

  • General Acute Care Hospital
  • Austell, GA
  • NPI 1467420448
  Care Compare affiliation
• Douglas Hospital, Inc.

  • General Acute Care Hospital
  • Douglasville, GA
  • NPI 1649247974
  Care Compare affiliation
• Kennestone Hospital, Inc.

  • General Acute Care Hospital
  • Marietta, GA
  • NPI 1649248626
  Care Compare affiliation

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

{
    "created_epoch": "1466294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1376993519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2145 WILMINGTON CIR NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300621694",
            "telephone_number": "678-570-9637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 COBB PKWY S STE 60",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300606531",
            "telephone_number": "888-663-6331",
            "fax_number": "415-252-7176"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Piedmont Rd",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300663636",
            "country_code": "US",
            "telephone_number": "866-389-2727",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRISIBE",
        "first_name": "MODUPEOLA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-19",
        "last_updated": "2025-04-17",
        "certification_date": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "192602",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN192902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie D Bright, PA-C
• Brighter Care ABA Ga LLC
• Katherine Nicole Brignoni, FNP-C
• Linda D Briks, LMSW
• Keyana Brinson, PHARMD
• British American Properties LLC
• Jonathan Britt, LMT
• Nicole Lindstrom Brock, PA-C
• Stephanie Brock
• Tara Brock, RBT

• Family Nurse Practitioner in Marietta, GA
• Providers in Marietta, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2025; 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.