NPIMap

Individual provider Active NPI

Basil Ezenwa, MD

  • Emergency Medicine Physician
  • Columbus, GA
National Provider Identifier
1942244280
Registry record updated Mar 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
37797 Issued in GA
Practice address
616 19TH St
Columbus, GA 31901-1528
Phone
(904) 805-1300
Fax
(904) 805-1302
NPI assigned
Jun 16, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 19, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 37797 GA Primary

Addresses

Primary practice location

616 19TH St
Columbus, GA 31901-1528

Mailing address

PO Box 532724
Atlanta, GA 30353-2724
Phone (904) 805-1300

Other identifiers 3

IdentifierTypeStateIssuer
009922855MedicaidAL
000580082DMedicaidGA
616430OtherGABLUE CROSS

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
I20040716000852 GA Practitioner - Emergency MedicinePractitioner - Internal Medicine 3173502762 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Internal Medicine
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Current Care PAGroup PAC ID 9739260019, 545 clinicians

Practice addresses (Care Compare)

220 N Cobb Pkwy
Suite 400
Marietta, GA 30062-3579
Phone (770) 424-7125

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
37797GAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hartwell Emergency Physicians LLC Emergency Medicine Current Accepting new patients
Hartwell Emergency Physicians LLC Emergency Medicine CurrentSince Feb 1, 2010 Accepting new patients
United Emergency Services, Inc. Emergency Medicine Past Accepting new patients
Morningside Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Afc Physicians of Georgia Primary Care, PC Past Accepting new patients
Inphynet Primary Care Physicians Southeast PC Emergency Medicine Past Accepting new patients
Regional Urgent Care Center, LLC Past Accepting new patients
Sterling Emergency Services of the Southeast Inc Emergency Medicine Past Accepting new patients
Acs Primary Care Physicians - Southeast PC Emergency Medicine Past Accepting new patients

Locations

138 W Gibson St
Hartwell, GA 30643
Phone (702) 223-3333

Organizations & group practices 10

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": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205884800000",
    "number": "1942244280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 532724",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303532724",
            "telephone_number": "904-805-1300",
            "fax_number": "904-805-1302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 19TH ST",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319011528",
            "telephone_number": "904-805-1300",
            "fax_number": "904-805-1302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZENWA",
        "first_name": "BASIL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2008-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "37797",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009922855",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000580082D",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "616430",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, GA

Sources for this page

Verify at the official NPI Registry.