Victor Osisanya, M.D.

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

License

71689 Issued in GA

Practice address

2550 Windy Hill Rd SE Ste 215
Ste 215
Marietta, GA 30067-8654

Phone

(770) 850-8464

Fax

(770) 850-9727

NPI assigned

Jun 23, 2010

Last updated

Feb 19, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 6

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• KCP Enterprises

  dba Elite Medical and Rehab

  • Physical Medicine & Rehabilitation Physician
  • Morrow, GA
  • NPI 1043679418
  Medicare reassignment NPD
• NGX Lawrenceville Ga PC

  • Physical Medicine & Rehabilitation Physician
  • Lawrenceville, GA
  • NPI 1730804642
  NPD
• Beyond Mental Health Wellness LLC

  • Anesthesiology Physician
  • Woodstock, GA
  • NPI 1174232151
  NPD (past)

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

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424304000000",
    "number": "1679884753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 WINDY HILL RD SE STE 215",
            "address_2": "STE 215",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300678654",
            "telephone_number": "770-850-8464",
            "fax_number": "770-850-9727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 WINDY HILL RD SE STE 215",
            "address_2": "STE 215",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300678654",
            "telephone_number": "770-850-8464",
            "fax_number": "770-850-9727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSISANYA",
        "first_name": "VICTOR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-23",
        "last_updated": "2015-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "GA",
            "license": "71689",
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "GA",
            "license": "71689",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "GA",
            "license": "71689",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003153374F",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003153374B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003153374D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003153374E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003153374G",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003153374C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gavin Osborne
• Aminta Osejo, LAPC, CADC II, NCC
• Renea Johnson Oseni, PHD
• Keira Oseroff, LCSW CEDS
• Blue Osibogun
• Nasra Osman, PA
• Oss Care & Consulting, LLC
• Jeanette Lynn Ostell, MASSAGE THERAPIST
• Patrick Jacob Oster, D. C.
• Andrew Kenneth Ostrowski, M.D.

• Pain Medicine Physician in Marietta, GA
• Providers in Marietta, GA by specialty
• Pain Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2015; 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.