Individual provider Active NPI

Chioma Oti, D.O

  • Emergency Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1841429883
Registry record updated Jan 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
OTO12845 Issued in PA
Practice address
3998 Red Lion Rd
Philadelphia, PA 19114-1445
Phone
(215) 612-2691
NPI assigned
Jul 13, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X OTO12845 PA
Emergency Medicine Physician 207P00000X OTO12845 PA Primary

Addresses

Primary practice location

3998 Red Lion Rd
Philadelphia, PA 19114-1445

Mailing address

3998 Red Lion Rd
Philadelphia, PA 19114-1445
Phone (215) 612-2691

Other identifiers 1

IdentifierTypeStateIssuer
OTO12845MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq Health Information Exchange (HIE) Permanente Medical Group

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
I20141021003079 GA Practitioner - Emergency Medicine 8921229691 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
New York College of Osteo Medicine of New York Institute of Technology, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Southeast Permanente Medical GroupGroup PAC ID 6204829013, 823 clinicians

Practice addresses (Care Compare)

750 Townpark LN NW
Kennesaw, GA 30144-5579
Phone (770) 514-5405

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OTO12845PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Acs Primary Care Physicians - Southeast PC Emergency Medicine CurrentSince Jul 31, 2019 Accepting new patients
Angelfish Emergency Physicians, LLC Emergency Medicine CurrentSince Mar 20, 2020 Accepting new patients
The Bortolazzo Group, LLC Emergency Medicine CurrentSince Jul 1, 2014 Accepting new patients
Phoebe Putney Memorial Hospital Inc CurrentSince Aug 1, 2016 Accepting new patients
Phoebe Putney Memorial Hospital Inc CurrentSince Aug 1, 2016 Accepting new patients
The Southeast Permanente Medical Group Internal Medicine CurrentSince Dec 3, 2018 Accepting new patients

Locations

417 W 3rd Ave
Albany, GA 31701
Phone (229) 317-2207

3495 Piedmont Rd NE
Bldg 9
Atlanta, GA 30305
Phone (404) 364-7000

3651 Wheeler Rd
Augusta, GA 30909
Phone (706) 651-3232

3950 Austell Rd
Austell, GA 30106
Phone (770) 732-3752

5126 Hospital Dr NE
Covington, GA 30014
Phone (770) 385-4340

750 Townpark Ln NW
Kennesaw, GA 30144
Phone (770) 514-5401

2151 W Spring St
Monroe, GA 30655
Phone (770) 267-1792

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1247443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642032000000",
    "number": "1841429883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3998 RED LION RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191141445",
            "telephone_number": "215-612-2691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3998 RED LION RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191141445",
            "telephone_number": "215-612-2691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTI",
        "first_name": "CHIOMA",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-13",
        "last_updated": "2022-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OTO12845",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "OTO12845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OTO12845",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "750 Townpark Ln NW",
            "city": "Kennesaw",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301445579",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.