Omar S Queensbourrow, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

006678 Issued in GA

Practice address

5185 Old National Hwy
Atlanta, GA 30349-3244

Phone

(404) 763-9300

Fax

(404) 763-9306

NPI assigned

Nov 19, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Health Services of Central Georgia 300 clinicians

Wellstreet of Georgia PC 425 clinicians

The Southeast Permanente Medical Group 823 clinicians

Bristol Bay Area Health Corporation 114 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Atrium Health Navicent the Medical Center Hospital, Macon, GA, CCN 110107
• Bristol Bay Dba Kanakanak Hospital Hospital, Dillingham, AK, CCN 021309

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: oqueensbourrow2941838@carolinashealthcaresystem.direct-ci.com

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.

• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956

  GA

  Medicare reassignment Care Compare group NPD
• Health Services of Central Georgia, Inc

  • Multi-Specialty Clinic/Center
  • Macon, GA
  • NPI 1184679482

  GA

  Medicare reassignment Care Compare group
• Wellstreet of Georgia PC

  • Urgent Care Clinic/Center
  • Newnan, GA
  • NPI 1235411547

  GA

  Medicare reassignment Care Compare group
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Aleknagik North, AK
  • NPI 1235291246

  TX

  Medicare reassignment Care Compare group
• The Medical Center of Central Georgia Inc.

  • Home Health Agency
  • Macon, GA
  • NPI 1831287655

  GA

  Medicare reassignment NPD
• Bristol Bay Area Health Corporation

  • Medicare Defined Swing Bed Hospital Unit
  • Dillingham, AK
  • NPI 1770645202
  Care Compare group NPD
• Coweta Emergency Group LLC

  • Emergency Medicine Physician
  • Newnan, GA
  • NPI 1245556588

  GA

  Medicare reassignment
• Houston County Emergency Group, LLC

  • Emergency Medicine Physician
  • Warner Robins, GA
  • NPI 1013338193

  GA

  Medicare reassignment
• Peach Emergency Group LLC

  • Emergency Medicine Physician
  • Byron, GA
  • NPI 1902165327

  GA

  Medicare reassignment
• Peachtree Immediate Care FP, LLC

  • Family Medicine Physician
  • Hiram, GA
  • NPI 1437194156

  GA

  Medicare reassignment
• South Atlanta Urgent Care Clinic LLC

  • Urgent Care Clinic/Center
  • Atlanta, GA
  • NPI 1144548363

  GA

  Medicare reassignment
• Swift Health Medical Group

  • Urgent Care Clinic/Center
  • Morrow, GA
  • NPI 1811434210

  GA

  Medicare reassignment

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• The Medical Center of Central Georgia Inc

  • General Acute Care Hospital
  • Macon, GA
  • NPI 1043270564

  Hospital

  Care Compare affiliation
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Togiak, AK
  • NPI 1093877680

  Hospital

  Care Compare affiliation
• Bristol Bay Area Health Corporation

  • Critical Access Hospital
  • Dillingham, AK
  • NPI 1831270842

  Hospital

  Care Compare affiliation
• Bristol Bay Area Health Corporation

  • Critical Access Hospital
  • Dillingham, AK
  • NPI 1962688309

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1353283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628035200000",
    "number": "1841534591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "198 GREENVIEW TER",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312208755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5185 OLD NATIONAL HWY",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303493244",
            "telephone_number": "404-763-9300",
            "fax_number": "404-763-9306"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6053 Jonesboro Rd",
            "address_purpose": "LOCATION",
            "city": "Morrow",
            "state": "GA",
            "postal_code": "302601106",
            "country_code": "US",
            "telephone_number": "770-824-4343",
            "fax_number": "678-519-1089",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "QUEENSBOURROW",
        "first_name": "OMAR",
        "middle_name": "S",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-11-19",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA 9106708",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "006678",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Quattlebaum, SLP
• Chastity Quave, LCSW
• Naria S Quazi, MD, MPH
• Queen of Hearts Nutrition LLC
• Barron D Queen
• Brittany Elizabeth Quesinberry, AGACNP-BC
• Quest 35, Inc.
• Quest Diagnostics Incorporated
• Quest Psychological Services, LLC
• Tammie E Quest, MD

• All providers in Atlanta, GA
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; 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.

Verify at the official NPI Registry.