NPIMap

Individual provider Active NPI

Maisara Kobaisy, M.D.

  • Internal Medicine Physician
  • Brunswick, GA
National Provider Identifier
1841590908
Registry record updated Oct 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
073016 Issued in GA
Practice address
2415 Parkwood Drive
Brunswick, GA 31520-4722
Phone
(912) 466-7188
Fax
(912) 466-7185
NPI assigned
Oct 23, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125.058930 IL
Hospitalist Physician 208M00000X 073016 GA
Internal Medicine Physician 207R00000X 073016 GA Primary

Addresses

Primary practice location

2415 Parkwood Drive
Brunswick, GA 31520-4722

Mailing address

2415 Parkwood Drive
Brunswick, GA 31520-4722
Phone (912) 466-7188

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150306000980 GA Practitioner - Internal Medicine 2062738297 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cooperative Healthcare Services IncGroup PAC ID 9830093640, 235 clinicians
Chronic Disease Management of Georgia LLCGroup PAC ID 7618306721, 76 clinicians

Practice addresses (Care Compare)

2415 Parkwood Dr
Brunswick, GA 31520-4722
Phone (912) 466-4079

704 Breedlove Dr
Suite a
Monroe, GA 30655-2054
Phone (888) 772-0076

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Brunswick, GA, CCN 117144
  • Hearth Hospice of Brunswick, LLC Hospice, Brunswick, GA, CCN 851531
  • Southeast Georgia Health System- Brunswick Campus Hospital, Brunswick, GA, CCN 110025
  • Heritage Oaks Nursing home, Saint Simons Island, GA, CCN 115582

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125.058930ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chronic Disease Management of Georgia, LLC CurrentSince Aug 1, 2023 Accepting new patients
Emergency Physicians Inc CurrentSince Jun 1, 2020 Accepting new patients
Transitional Care Physicians of Georgia PC CurrentSince Oct 1, 2021 Accepting new patients
Cooperative Healthcare Services Inc Internal Medicine CurrentSince Nov 17, 2014 Accepting new patients
Southeast Georgia Health System, Inc. Past Accepting new patients
Glynn County Healthcare, LLC Past Accepting new patients

Locations

2415 Parkwood Dr
Brunswick, GA 31520
Phone (912) 466-4079

704 Breedlove Dr
#A
Monroe, GA 30655
Phone (888) 772-0076

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Hearth Hospice of Brunswick, LLCBrunswick, GA, CCN 851531 Hospice Contracted Managing Employee Oct 1, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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.

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": "1287792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634601600000",
    "number": "1841590908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2415 PARKWOOD DRIVE",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204722",
            "telephone_number": "912-466-7188",
            "fax_number": "912-466-7185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2415 PARKWOOD DRIVE",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204722",
            "telephone_number": "912-466-7188",
            "fax_number": "912-466-7185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOBAISY",
        "first_name": "MAISARA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-23",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125.058930",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "GA",
            "license": "073016",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "073016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brunswick, GA

Sources for this page

Verify at the official NPI Registry.