NPIMap

Individual provider Active NPI

Enoch K Asiedu, PA-C

  • Vascular & Interventional Radiology Physician
  • Atlanta, GA
National Provider Identifier
1700385374
Registry record updated Nov 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
10395 Issued in GA
Practice address
1364 Clifton Rd NE Ste D112
Atlanta, GA 30322-2401
Phone
(718) 920-5013
Fax
(718) 920-2629
NPI assigned
Feb 8, 2018
Last updated
Nov 20, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X 10395 GA Primary

Addresses

Primary practice location

1364 Clifton Rd NE Ste D112
Atlanta, GA 30322-2401

Mailing address

1641 Brandon Glen Way NE
Conyers, GA 30012-3888
Phone (718) 314-5598

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, GA2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20180503000523 NY Practitioner - Physician Assistant 8628332459 Reassigns benefits to 2 organizations
I20210916000741 GA Practitioner - Physician Assistant 8628332459 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Emory Clinic IncGroup PAC ID 8820901408, 3,507 clinicians

Practice addresses (Care Compare)

1365 Clifton Rd NE
Atlanta, GA 30322-1013
Phone (404) 778-7525

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.51 of 100Reported as apm
Quality
80.61
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10395GAMDMusic Therapist
021884NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Apr 13, 2018 Accepting new patients
The Emory Clinic Inc CurrentSince Oct 18, 2021 Accepting new patients
Montefiore Medical Center CurrentSince Apr 13, 2018 Accepting new patients
Montefiore Medical Center Past Accepting new patients

Locations

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

101 W Ponce de Leon Ave
Decatur, GA 30030
Phone (404) 778-4889

111 E 210th St
Bronx, NY 10467

1650 Grand Concourse
Bronx, NY 10457
Phone (718) 294-7104

Interoperability endpoints

  • Direct secure messaging: easiedu58881@direct.emory.org

Organizations & group practices 5

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 4

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": "1518048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637366400000",
    "number": "1700385374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1641 BRANDON GLEN WAY NE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123888",
            "telephone_number": "718-314-5598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1364 CLIFTON RD NE STE D112",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303222401",
            "telephone_number": "718-920-5013",
            "fax_number": "718-920-2629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ASIEDU",
        "first_name": "ENOCH",
        "middle_name": "K",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-08",
        "last_updated": "2021-11-20",
        "certification_date": "2021-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "GA",
            "license": "10395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.