Olaniyi Olabode Osofisan, M.D.

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

053797 Issued in GA

Practice address

1404 River PL Ste 501
Braselton, GA 30517-5600

Phone

(770) 848-7160

NPI assigned

Oct 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA, IL, MT3 enrollments

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 3

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: oosofisan155046@nghs.gadirect.net

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.

• Bozeman Health Deaconess Hospital

  • Family Medicine Physician
  • Bozeman, MT
  • NPI 1619347390
  Medicare reassignment NPD
• Methodist Medical Center of Illinois

  • Rehabilitation Hospital Unit
  • Peoria, IL
  • NPI 1982656575
  Medicare reassignment NPD
• Pekin Prohealth Inc

  • Family Medicine Physician
  • Pekin, IL
  • NPI 1932150299
  Medicare reassignment NPD
• Proctor Health Systems

  • Family Medicine Physician
  • Peoria, IL
  • NPI 1134173917
  Medicare reassignment NPD
• Belgrade Clinic PLLP

  • Family Medicine Physician
  • Belgrade, MT
  • NPI 1447280912
  NPD
• Bozeman Health Deaconess Hospital

  • Durable Medical Equipment & Medical Supplies
  • Bozeman, MT
  • NPI 1013733955
  NPD
• Bozeman Health Deaconess Hospital

  • Emergency Medicine Physician
  • Bozeman, MT
  • NPI 1437529112
  NPD
• Methodist Medical Center of Illinois

  • General Acute Care Hospital
  • Peoria, IL
  • NPI 1164474755
  NPD
• Methodist Medical Center of Illinois

  • Family Medicine Physician
  • Peoria, IL
  • NPI 1184670663
  NPD
• Proctor Health Systems

  • Rural Health Clinic/Center
  • Princeville, IL
  • NPI 1356057301
  NPD
• Bozeman Health Deaconess Hospital

  • General Acute Care Hospital
  • Bozeman, MT
  • NPI 1104295864
  NPD (past)
• Indiana University Health Southern Indiana Physicians, LLC

  • Multi-Specialty Clinic/Center
  • Bloomington, IN
  • NPI 1013953983

  Cardiovascular Disease

  NPD (past)

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744156800000",
    "number": "1447333554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 742616",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303742616",
            "telephone_number": "770-219-8420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 RIVER PL STE 501",
            "city": "BRASELTON",
            "state": "GA",
            "postal_code": "305175600",
            "telephone_number": "770-848-7160"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3459 Acworth Due West Rd NW",
            "address_2": "Suite 559",
            "address_purpose": "LOCATION",
            "city": "Acworth",
            "state": "GA",
            "postal_code": "301015819",
            "country_code": "US",
            "telephone_number": "770-529-7922",
            "fax_number": "770-529-7931",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "937 Highland Blvd",
            "address_purpose": "LOCATION",
            "city": "Bozeman",
            "state": "MT",
            "postal_code": "597156909",
            "country_code": "US",
            "telephone_number": "406-414-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OSOFISAN",
        "first_name": "OLANIYI",
        "middle_name": "OLABODE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "GA",
            "license": "053797",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MT",
            "license": "148664",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "173191749A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "oosofisan155046@nghs.gadirect.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1404 River Pl Ste 501",
            "city": "Braselton",
            "state": "GA",
            "country_code": "US",
            "postal_code": "305175600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ebere Obasi
• Donna Anne Offenhauer, PHARMD
• Susan B Oh, M.D.
• Erica Okoli, MD,MHS
• Laura Osborne
• Candice Owens, FNP-C
• Adebimpe Wakilat Oyowe, M.D. PHD.
• Anna E. Packer, MA, LPC
• Adelina Paduraru, MS, RD, LD
• Joel Nathaniel Palmer, D.O.

• Cardiovascular Disease Physician in Braselton, GA
• Providers in Braselton, GA by specialty
• Cardiovascular Disease Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.