Individual provider Active NPI

Vandra C Okafor, M.D.

  • Pediatric Otolaryngology Physician
  • Atlanta, GA
National Provider Identifier
1861828097
Registry record updated Jan 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Otolaryngology PhysicianTaxonomy code 207YP0228X
License
94312 Issued in GA
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

Updated by the provider on Jan 10, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210215000012 IL Practitioner - Otolaryngology 2769606201 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
94312GAMDPediatric Otolaryngology Physician
U0355TXMDPediatric Otolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Medical Services, NFP CurrentSince Jan 4, 2021 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

  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.