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PROVIDENCE MEDICAL GROUP, PC
NPI 1063570604
Internal Medicine in Atlanta, GA

Active since December 05, 2006
550 PEACHTREE ST NE, SUITE 1285, ATLANTA, GA 30308(404) 856-3213(404) 856-3217 Get Directions Write a Review

NPPES record last updated: June 19, 2012. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Providence Medical Group, Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE MEDICAL GROUP, PC (NPI 1063570604) is a healthcare organization registered as an internal medicine in Atlanta, Georgia and active in the NPI registry since December 2006. The organization lists Oladayo Adisa Osinuga, President, as its authorized official.

NPPES Registry Identity

NPI1063570604
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NamePROVIDENCE MEDICAL GROUP, PC
Location Address550 PEACHTREE ST NE, SUITE 1285Atlanta, GA 30308-2249
Mailing AddressPo Box 4047Macon, GA 31208-4047 · (404) 856-3213 · Fax (404) 856-3217
Phone(404) 856-3213
Fax(404) 856-3217
Organization SubpartNo
Authorized OfficialOladayo Adisa OsinugaPresident · (404) 684-7111
Enumeration DateDecember 5, 2006
Last NPPES UpdateJune 19, 2012
✔ NPI 1063570604 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in GA · 051703
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
550 PEACHTREE ST NE, Atlanta, GA 30308
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Providence Medical Group, Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Providence Medical Group, PC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Oladayo Osinuga, MD
Internal Medicine
NPI 1396716312
1170 CLEVELAND AVE
Atlanta, GA 30344
(404) 466-1170
✔ PECOS✔ Accepts Medicare6.6 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Providence Medical Group, PC's NPI number?

The NPI number for Providence Medical Group, PC is 1063570604. It was assigned to this organization in the NPPES registry on December 5, 2006.

Where is Providence Medical Group, PC located?

Providence Medical Group, PC is located at 550 Peachtree St NE Suite 1285, Atlanta, GA 30308. The listed phone number is (404) 856-3213.

What is Providence Medical Group, PC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Providence Medical Group, PC enrolled in Medicare?

Yes. Providence Medical Group, PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Providence Medical Group, PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Providence Medical Group, PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Providence Medical Group, PC was last updated on June 19, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.