Active NPI
Vandra C Okafor, M.D.
- Pediatric Otolaryngology Physician
- Atlanta, GA
National Provider Identifier
1861828097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Otolaryngology Physician
- License
- 94312
- Practice address
- 5461 Meridian Mark Rd
Atlanta, GA 30342-3007 - Phone
- (404) 255-2033
- NPI assigned
- Sep 19, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Otolaryngology Physician | 207YP0228X | 94312 | GA | Primary |
| Otolaryngology Physician | 207Y00000X | 036154045 | IL | |
| Pediatric Otolaryngology Physician | 207YP0228X | U0355 | TX | |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
5461 Meridian Mark Rd
Atlanta, GA 30342-3007
Mailing address
5461 Meridian Mark Rd
Atlanta, GA 30342-3007
Other practice location 1
2601 W Main St
Carbondale, IL 62901-1031
Phone (618) 549-5361
Other practice location 2
2601 W Main St
Carbondale, IL 62901-1031
Phone (618) 351-7300
Other practice location 3
1800 Orleans St
Baltimore, MD 21287
Phone (410) 502-5186
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 94312 | GA | MD | Pediatric Otolaryngology Physician |
| U0355 | TX | MD | Pediatric Otolaryngology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern Illinois Medical Services, NFP | Current | Accepting new patients | |
| Choa Multispecialty, LLC | Pediatric Otolaryngology | Past | Accepting new patients |
Locations
2601 W Main St
Carbondale, IL 62901
Phone (618) 351-7300
Interoperability endpoints
- vharris38069@sih.direct-ci.com
Organizations & group practices 2
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.
-
- Internal Medicine Physician
- Carbondale, IL
- NPI 1770656837
-
- Pediatrics Physician
- Brookhaven, GA
- NPI 1437493467
Pediatric Otolaryngology
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1379548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704844800000",
"number": "1861828097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5461 MERIDIAN MARK RD",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303423007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5461 MERIDIAN MARK RD",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303423007",
"telephone_number": "404-255-2033"
}
],
"practiceLocations": [
{
"address_1": "2601 W Main St",
"address_purpose": "LOCATION",
"city": "Carbondale",
"state": "IL",
"postal_code": "629011031",
"country_code": "US",
"telephone_number": "618-549-5361",
"fax_number": "618-351-4878",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2601 W Main St",
"address_purpose": "LOCATION",
"city": "Carbondale",
"state": "IL",
"postal_code": "629011031",
"country_code": "US",
"telephone_number": "618-351-7300",
"fax_number": "618-457-7890",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1800 Orleans St",
"address_purpose": "LOCATION",
"city": "Baltimore",
"state": "MD",
"postal_code": "21287",
"country_code": "US",
"telephone_number": "410-502-5186",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "OKAFOR",
"first_name": "VANDRA",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-09-19",
"last_updated": "2024-01-10",
"certification_date": "2024-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "207YP0228X",
"taxonomy_group": "",
"desc": "Otolaryngology, Pediatric Otolaryngology",
"state": "GA",
"license": "94312",
"primary": true
},
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "IL",
"license": "036154045",
"primary": false
},
{
"code": "207YP0228X",
"taxonomy_group": "",
"desc": "Otolaryngology, Pediatric Otolaryngology",
"state": "TX",
"license": "U0355",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.