Kaissa Desta Idahosa, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN227597 Issued in GA

Practice address

2480 Windy Hill Rd SE
Marietta, GA 30067-8644

Phone

(800) 640-3451

NPI assigned

Feb 15, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Kaissa Benth Former name

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Grady Memorial Hospital CorporationGroup PAC ID 7517032998, 365 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Grady Memorial Hospital Hospital, Atlanta, GA, CCN 110079

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Grady Memorial Hospital Corporation

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1114243813
  Medicare reassignment Care Compare group NPD
• Blue Ridge Hospice, Inc.

  • Community Based Hospice Care Agency
  • Canton, GA
  • NPI 1427641067
  Medicare reassignment NPD
• Grady Memorial Hospital Corporation

  • Rehabilitation Hospital
  • Atlanta, GA
  • NPI 1336961119
  NPD
• Grady Memorial Hospital Corporation

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1992799050
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Grady Memorial Hospital Corporation

  • General Acute Care Hospital
  • Atlanta, GA
  • NPI 1992799050
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727913600000",
    "number": "1942955323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1200",
            "city": "PLEASANT GROVE",
            "state": "UT",
            "postal_code": "840621200",
            "telephone_number": "800-640-3451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2480 WINDY HILL RD SE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300678644",
            "telephone_number": "800-640-3451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDAHOSA",
        "first_name": "KAISSA",
        "middle_name": "DESTA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-15",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN227597",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN227597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAISSA",
            "last_name": "BENTH",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Iain Halstead LLC
• Waunelle Jackson Ian, DDS
• Ib Medsupply Inc
• Catherine Ibarra
• Christian Ibarra, DPT
• Osayoboyi Idahosa, BCBA
• Niamah Iddeen
• Ideal Dental Powers Park PC
• Iface Academy
• Alfie Victoria Igbadume

• Family Nurse Practitioner in Marietta, GA
• Providers in Marietta, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.