Benjamin Otiwu

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

148574 Issued in GA

Practice address

3965 Bradford Walk TRL
Buford, GA 30519-7840

Phone

(678) 488-1093

NPI assigned

Jul 26, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emory Specialty Associates, LLCGroup PAC ID 3476559782, 706 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Emory Johns Creek Hospital Hospital, Johns Creek, GA, CCN 110230

Medicare enrollment (NPD)

Enrolled

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.

• Emory Specialty Associates, LLC

  • Anesthesiology Physician
  • Lagrange, GA
  • NPI 1407864168

  GA

  Medicare reassignment Care Compare group NPD

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

• Ehca Johns Creek, LLC

  • General Acute Care Hospital
  • Johns Creek, GA
  • NPI 1679632137

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1690329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715299200000",
    "number": "1992486591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3965 BRADFORD WALK TRL",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305197840",
            "telephone_number": "678-488-1093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3965 BRADFORD WALK TRL",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305197840",
            "telephone_number": "678-488-1093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTIWU",
        "first_name": "BENJAMIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-07-26",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN283773",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "148574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria de Los a Oropeza Guerrero
• Kimberly Christine Oros, MS,CCC-SLP
• Ortho Sport & Spine Physicians Buford
• Tolulope A Osemwegie, LPC
• Osprey Pharmacy RX Corp
• Justin Otiwu
• Otto Bock Patient Care, LLC
• Overcomers Youth Residential Home
• Lisa Zainab Owusus Mensah, RN
• Owa I Oyibo, RN

• All providers in Buford, GA
• Certified Registered Nurse Anesthetist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.