Active NPI
Omolara B Kuteyi, M.D.
- Family Medicine Physician
- Decatur, GA
National Provider Identifier
1780648568
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 053776
- Practice address
- 3546 Covington Hwy
Ste C
Decatur, GA 30032-1823 - Phone
- (404) 284-7744
- Fax
- (404) 284-8006
- NPI assigned
- Apr 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 053776 | GA | Primary |
Addresses
Primary practice location
3546 Covington Hwy
Ste C
Decatur, GA 30032-1823
Mailing address
1262 Emma Jean PL SW
Marietta, GA 30064-3798
Phone (404) 284-7744
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 053776 | Other | GA | PHYSICIAN LICENSE |
| 10040207 | Other | GA | AMERIGROUP |
| 200819 | Other | GA | BLUE CROSS BLUE SHIELD |
| 774394819B | Other | GA | PEACHSTATE |
| P00183443 | Other | GA | RAILROAD |
| 774394819C | Medicaid | GA | |
| 774394819D | Medicaid | GA | |
| 319682 | Other | GA | WELLCARE |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
495 Winn Way
Suite 100
Decatur, GA 30030-1709
Phone (404) 284-7744
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Omolara Kuteyi MD, Inc | Family Medicine | Current | Accepting new patients |
| Covington Family Care and Specialty Group | Current | Accepting new patients | |
| Physicians Primary Care Group Inc. | Family Medicine | Past | Accepting new patients |
| 2801 Felton Avenue, L.P. | Past | Accepting new patients |
Locations
1706 Lakewood Ave SE
Atlanta, GA 30315
Phone (404) 624-0475
3546 Covington Hwy
Ste C
Decatur, GA 30032
Phone (404) 284-7744
495 Winn Way
Ste 100
Decatur, GA 30030
Phone (404) 284-7744
495 Winn Way
Decatur, GA 30030
Phone (404) 389-0077
2801 Felton Dr
East Point, GA 30344
Phone (404) 767-7591
Organizations & group practices 4
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.
-
- Family Medicine Physician
- Decatur, GA
- NPI 1235343088
-
- Primary Care Clinic/Center
- Decatur, GA
- NPI 1942352778
-
- Skilled Nursing Facility
- East Point, GA
- NPI 1336525005
-
- Family Medicine Physician
- Atlanta, GA
- NPI 1295924157
Hospital & facility affiliations 1
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": "1145232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323216000000",
"number": "1780648568",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1262 EMMA JEAN PL SW",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300643798",
"telephone_number": "404-284-7744",
"fax_number": "404-284-8006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3546 COVINGTON HWY",
"address_2": "STE C",
"city": "DECATUR",
"state": "GA",
"postal_code": "300321823",
"telephone_number": "404-284-7744",
"fax_number": "404-284-8006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUTEYI",
"first_name": "OMOLARA",
"middle_name": "B",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-17",
"last_updated": "2011-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "053776",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIAN LICENSE",
"identifier": "053776",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP",
"identifier": "10040207",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "200819",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PEACHSTATE",
"identifier": "774394819B",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD",
"identifier": "P00183443",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "774394819C",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "774394819D",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "319682",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Decatur, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2011; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.