Individual provider Active NPI

Chisom Justin Mbonu, MD

  • Hospitalist Physician
  • Atlanta, GA
National Provider Identifier
1902241946
Registry record updated Aug 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
076439 Issued in GA
Practice address
35 Collier Rd NW
Suite 635
Atlanta, GA 30309-1613
Phone
(404) 367-3014
NPI assigned
May 3, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2020

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 076439 GA
Hospitalist Physician 208M00000X 076439 GA Primary

Addresses

Primary practice location

35 Collier Rd NW
Suite 635
Atlanta, GA 30309-1613

Mailing address

35 Collier Rd NW
Suite 635
Atlanta, GA 30309-1613
Phone (404) 367-3014

Other practice location 1

2518 Jimmy Lee Smith Pkwy
Hiram, GA 30141-2068
Phone (470) 644-8027

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cmbonu374922@directwellstar.org

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
I20160907002016 GA Practitioner - HospitalistPractitioner - Internal Medicine 8729380787 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

2518 Jimmy Lee Smith Pkwy
Hiram, GA 30141-2068
Phone (770) 732-4022

5150 Stilesboro N W Rd
Suite 220
Kennesaw, GA 30152-7742
Phone (770) 424-8222

Hospital & facility affiliations

  • Wellstar Paulding Medical Center Hospital, Hiram, GA, CCN 110042
  • Wellstar Cobb Medical Center Hospital, Austell, GA, CCN 110143

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince May 1, 2020 Accepting new patients
Cogent Healthcare of Georgia PC Internal Medicine CurrentSince Aug 1, 2018 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Mount Lassen Emergency Physicians LLC Past Accepting new patients

Locations

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370

1170 Cleveland Ave
East Point, GA 30344
Phone (404) 305-3500

2518 Jimmy Lee Smith Pkwy
Hiram, GA 30141
Phone (470) 644-7000

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

Organizations & group practices 4

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 2

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": "1367539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598486400000",
    "number": "1902241946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 COLLIER RD NW",
            "address_2": "SUITE 635",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091613",
            "telephone_number": "404-367-3014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 COLLIER RD NW",
            "address_2": "SUITE 635",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091613",
            "telephone_number": "404-367-3014"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2518 Jimmy Lee Smith Pkwy",
            "address_purpose": "LOCATION",
            "city": "Hiram",
            "state": "GA",
            "postal_code": "301412068",
            "country_code": "US",
            "telephone_number": "470-644-8027",
            "fax_number": "470-644-8064",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MBONU",
        "first_name": "CHISOM",
        "middle_name": "JUSTIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-03",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "076439",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "GA",
            "license": "076439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cmbonu374922@directwellstar.org",
            "affiliation": "N",
            "address_1": "2518 Jimmy Lee Smith Pkwy",
            "city": "Hiram",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301412068",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.