Active NPI
Otabek Elmurodov, M.D.
- Internal Medicine Physician
- Statesboro, GA
National Provider Identifier
1972035632
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 081428
- Practice address
- 106 Briarwood Rd
Statesboro, GA 30458-2459 - Phone
- (912) 871-5000
- Fax
- (912) 681-1444
- NPI assigned
- Mar 31, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 081428 | GA | Primary |
Addresses
Primary practice location
106 Briarwood Rd
Statesboro, GA 30458-2459
Mailing address
PO Box 117598
Atlanta, GA 30368-7598
Phone (770) 442-1911
Other practice location 1
380 South Conyers Street
Metter, GA 30439
Phone (912) 685-3992
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39STUDENT | Other | MI | SINAI-GRACE HOSPITAL/DMC - TRANSITIONAL YEAR RESIDENCY PROGRAM |
| 1972035632 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC, GA, SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 3
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Other, 2006
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
2866 Johnson Ferry Rd
Suite 200
Marietta, GA 30062-8348
350 Bedford St
Suite 406a
Stamford, CT 06901-1738
920 Napiers Post Dr
Evans, GA 30809-6428
PO Box
Atlanta, GA 30368
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 081428 | GA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Med-Ped Health Care LLC | Internal Medicine | Current | Accepting new patients |
| Express Healthcare, LLC | Current | Accepting new patients | |
| Rural Urgent Care LLC | Current | Accepting new patients | |
| Physicians Services Group, P.C. | Current | Accepting new patients | |
| Rural Urgent Care LLC | Current | Accepting new patients | |
| Southeast Medical Group, P.C. | Past | Accepting new patients | |
| Express Healthcare, LLC | Past | Accepting new patients |
Locations
1245 Noah Dr
Jasper, GA 30143
Phone (706) 253-1954
6201 Greenbelt Rd
Ste M16
Berwyn Heights, MD 20740
Phone (301) 441-4400
6201 Greenbelt Rd
Ste M15
Berwyn Heights, MD 20740
Phone (301) 441-1112
Interoperability endpoints
- https://api.platform.athenahealth.com/19581/brand/1/csg/1/fhir/r4
- https://fhir4.healow.com/fhir/r4/DIJIBA
Organizations & group practices 7
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.
-
- Family Medicine Physician
- Berwyn Heights, MD
- NPI 1336296730
DC, Internal Medicine
-
- Multi-Specialty Clinic/Center
- Greenville, SC
- NPI 1700357076
-
- Family Medicine Physician
- Alpharetta, GA
- NPI 1235296054
-
- Rural Health Clinic/Center
- Eufaula, AL
- NPI 1588450316
-
- Urgent Care Clinic/Center
- College Park, MD
- NPI 1447605712
Hospital & facility affiliations 1
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": "1490918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773878400000",
"number": "1972035632",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 117598",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303687598",
"telephone_number": "770-442-1911",
"fax_number": "770-442-0306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106 BRIARWOOD RD",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304582459",
"telephone_number": "912-871-5000",
"fax_number": "912-681-1444"
}
],
"practiceLocations": [
{
"address_1": "380 South Conyers Street",
"address_purpose": "LOCATION",
"city": "Metter",
"state": "GA",
"postal_code": "30439",
"country_code": "US",
"telephone_number": "912-685-3992",
"fax_number": "912-685-3993",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ELMURODOV",
"first_name": "OTABEK",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-03-31",
"last_updated": "2026-03-19",
"certification_date": "2026-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "GA",
"license": "081428",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SINAI-GRACE HOSPITAL/DMC - TRANSITIONAL YEAR RESIDENCY PROGRAM",
"identifier": "39STUDENT",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1972035632",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Statesboro, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2026; 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.