NPIMap

Individual provider Active NPI

David O Osedo, PA-C

  • Physician Assistant
  • Memphis, TN
National Provider Identifier
1689805400
Registry record updated Oct 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
5959 Park Ave
Memphis, TN 38119-5200
Phone
(770) 874-5408
NPI assigned
Jul 28, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

5959 Park Ave
Memphis, TN 38119-5200

Mailing address

7095 Country Walk Dr
Cordova, TN 38018-5839

Other names 1

  • David Ouma Osedo Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, NC, TX, IA4 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20110223000340 GA Practitioner - Physician Assistant 0345387197 Reassigns benefits to 13 organizations
I20220119000091 NC Practitioner - Physician Assistant 0345387197 Reassigns benefits to 3 organizations
I20230221002178 TX Practitioner - Physician Assistant 0345387197 Reassigns benefits to 2 organizations
I20240511000406 IA Practitioner - Physician Assistant 0345387197 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1769TNMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Apr 17, 2023 Accepting new patients
Houston County Emergency Group, LLC CurrentSince May 13, 2017 Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Apr 17, 2023 Accepting new patients
Ton Sells Hospital CurrentSince Dec 19, 2022 Accepting new patients
Keen Immediate Care Clinic PastSince Apr 20, 2021 Accepting new patients
Ton Sells Hospital Past Accepting new patients
Tennessee Emergency Physicians, PLLC PastSince Feb 9, 2020 Accepting new patients

Locations

1601 Watson Blvd
Warner Robins, GA 31093
Phone (478) 322-5155

Interoperability endpoints

  • Direct secure messaging: dosedo25336@mlh.direct-ci.com
  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4
  • Direct secure messaging: dosedo120639@capefearvalley.direct-ci.com

Organizations & group practices 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1248739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254787200000",
    "number": "1689805400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7095 COUNTRY WALK DR",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380185839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5959 PARK AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381195200",
            "telephone_number": "770-874-5408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSEDO",
        "first_name": "DAVID",
        "middle_name": "O",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-28",
        "last_updated": "2009-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DAVID",
            "last_name": "OSEDO",
            "middle_name": "OUMA",
            "credential": "PA-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.