NPIMap

Individual provider Active NPI

Itoro Bassey Edet Daniels, MD

  • Internal Medicine Physician
  • Greensboro, GA
National Provider Identifier
1508202995
Registry record updated Sep 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
080742 Issued in GA
Practice address
803 S Main St
Greensboro, GA 30642
Phone
(706) 454-5114
Fax
(706) 454-5199
NPI assigned
May 13, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 8, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X R73852 AZ
Pediatrics Physician 208000000X R73852 AZ
Internal Medicine Physician 207R00000X 080742 GA Primary

Addresses

Primary practice location

803 S Main St
Greensboro, GA 30642

Mailing address

803 S Main St
Greensboro, GA 30642-1211

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181106003100 GA Practitioner - Internal Medicine 9931471232 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Medical College of Georgia School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Rehabilitation, LLC 1,935 clinicians
Oconee Valley Healthcare Inc 21 clinicians

Practice addresses (Care Compare)

2600 Compass Rd
Glenview, IL 60026-8001

803 S Main St
Greensboro, GA 30642-1211
Phone (706) 453-1201

Hospital & facility affiliations

  • Amedisys Home Health of Covington Home health agency, Covington, GA, CCN 117065
  • Enhabit Home Health Home health agency, Hartwell, GA, CCN 117069
  • St Marys Good Samaritan Hospital Hospital, Greensboro, GA, CCN 111329
  • Northside Hospital Hospital, Atlanta, GA, CCN 110161
  • St Mary'S Hospital Hospital, Athens, GA, CCN 110006
  • Putnam General Hospital Hospital, Eatonton, GA, CCN 111313
  • Piedmont Athens Regional Medical Center Hospital, Athens, GA, CCN 110074
  • St Marys Good Samaritan Hospital Nursing home, CCN 11Z329

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
080742GAMDInternal Medicine Physician
R73852AZMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oconee Valley Healthcare Inc CurrentSince Aug 1, 2018 Accepting new patients
Oconee Valley Healthcare Inc CurrentSince Aug 1, 2018 Accepting new patients
Oconee Valley Healthcare Inc Current Accepting new patients
Oconee Valley Healthcare Inc Current Accepting new patients
Oconee Valley Healthcare Inc Current Accepting new patients
St. Mary'S Good Samaritan Hospital, Inc. Past Accepting new patients
St. Mary'S Good Samaritan Hospital, Inc. Past Accepting new patients

Locations

114 Harmony Xing
Ste 5
Eatonton, GA 31024
Phone (706) 454-1210

5401 Lake Oconee Pkwy
Greensboro, GA 30642
Phone (706) 453-7331

803 S Main St
Greensboro, GA 30642
Phone (706) 453-1201

1040 Park Dr
Greensboro, GA 30642
Phone (706) 453-4945

1041 Park Dr
Greensboro, GA 30642
Phone (706) 453-4945

510 N Cobb St
Milledgeville, GA 31061
Phone (478) 414-1414

60 GA Highway 22 W
Milledgeville, GA 31061
Phone (478) 414-1414

Interoperability endpoints

  • Direct secure messaging: itoro.edet.1@15507.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/15507/brand/1/csg/1/fhir/r4

Organizations & group practices 10

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 8

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": "1368403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1508202995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 S MAIN ST",
            "city": "GREENSBORO",
            "state": "GA",
            "postal_code": "306421211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 S MAIN ST",
            "city": "GREENSBORO",
            "state": "GA",
            "postal_code": "30642",
            "telephone_number": "706-454-5114",
            "fax_number": "706-454-5199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDET DANIELS",
        "first_name": "ITORO",
        "middle_name": "BASSEY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-05-13",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "R73852",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "R73852",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "080742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, GA

Sources for this page

Verify at the official NPI Registry.