Individual provider Active NPI

Ebtisam Mohammed Alumin Osman, M.D

  • Neurology Physician
  • Atlanta, GA
National Provider Identifier
1659759207
Registry record updated Oct 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
84013 Issued in GA
Practice address
12 Executive Park Dr NE
Atlanta, GA 30329-2206
Phone
(404) 727-1452
NPI assigned
May 15, 2015
Last updated
Oct 1, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Neurology Physician 2084N0400X 84013 GA Primary

Addresses

Primary practice location

12 Executive Park Dr NE
Atlanta, GA 30329-2206

Mailing address

780 Canton Rd NE Ste 400
Marietta, GA 30060-7298
Phone (770) 422-3602

Other practice location 1

780 Canton Rd NE Ste 400
Marietta, GA 30060-7298
Phone (770) 422-3602

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ealuminosman376528@directwellstar.org

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
I20200819004088 GA Practitioner - Neurology 1658676382 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

1510 Vernon Rd
Lagrange, GA 30240-4131
Phone (706) 845-3905

1514 Vernon Rd
Lagrange, GA 30240-4131
Phone (706) 880-7222

2518 Jimmy Lee Smith Pkwy
Hiram, GA 30141-2068
Phone (770) 732-4022

2540 Windy Hill Rd
Marietta, GA 30067-8605
Phone (770) 644-1570

2540 Windy Hill Serd
Marietta, GA 30067-8605
Phone (770) 644-1274

2550 Windy Hill Rd SE
Suite 220
Marietta, GA 30067-8605
Phone (404) 321-9900

3000 Hospital Blvd
Roswell, GA 30076-4915
Phone (770) 751-2912

3747 Roswell Rd
Marietta, GA 30062-6227

3950 Austell Rd
Austell, GA 30106-1121
Phone (770) 732-4022

5150 Stilesboro N W Rd
Suite 220
Kennesaw, GA 30152-7742
Phone (770) 424-8222

601 S 8TH St
Griffin, GA 30224-4213
Phone (770) 228-2721

625 Church Nest
Marietta, GA 30060-1101
Phone (770) 422-2004

677 Church Nest
Marietta, GA 30060-1101

677 Church St NE
Suite 100P
Marietta, GA 30060-1101
Phone (470) 793-8585

780 Canton Nerd
Suite 400
Marietta, GA 30060-7298
Phone (770) 422-3602

780 Canton Rd NE
Marietta, GA 30060-7298
Phone (770) 422-3602

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Jul 1, 2020 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Wellstar Cardiovascular Medicine, LLC Past Accepting new patients

Locations

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

780 Canton Rd NE
Ste 400
Marietta, GA 30060
Phone (770) 422-3602

780 Canton Rd NE
Ste 410
Marietta, GA 30060
Phone (678) 370-0370

805 Sandy Plains Rd
Marietta, GA 30066
Phone (770) 792-1616

Interoperability endpoints

  • Direct secure messaging: ealuminosman376528@directwellstar.org

Organizations & group practices 3

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 5

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": "1431648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601510400000",
    "number": "1659759207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 CANTON RD NE STE 400",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607298",
            "telephone_number": "770-422-3602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 EXECUTIVE PARK DR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292206",
            "telephone_number": "404-727-1452"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "780 Canton Rd NE Ste 400",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300607298",
            "country_code": "US",
            "telephone_number": "770-422-3602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ALUMIN OSMAN",
        "first_name": "EBTISAM",
        "middle_name": "MOHAMMED",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-15",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "GA",
            "license": "84013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ealuminosman376528@directwellstar.org",
            "affiliation": "N",
            "address_1": "780 Canton Rd NE Ste 400",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300607298",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.