OMAR DAVID LOPEZ
NPI 1164162889
Emergency Medicine in Marietta, GA
About Omar David Lopez NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
OMAR DAVID LOPEZ (NPI 1164162889) is an individual emergency medicine provider in Marietta, Georgia, licensed in South Carolina (94179) and active in the NPI registry since March 2022. He is enrolled in Medicare PECOS, is affiliated with Wellstar Kennestone Regional Medical Center, and maintains a secondary practice location in Rock Hill.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Omar David Lopez is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
2Medicare enrollment records show Omar Lopez reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Austell, GA 30106
- Reassigned Medicare billing, Georgia enrollment
- 353 clinicians in this Medicare group
Myrtle Beach, SC 29572
- Reassigned Medicare billing, South Carolina enrollment
- 559 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Hospital Affiliations CMS Care Compare 3
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Wellstar Kennestone Regional Medical Center
Acute Care Hospitals · Marietta, GAPiedmont Medical Center
Acute Care Hospitals · Rock Hill, SCMusc Medical Center
Acute Care Hospitals · Charleston, SCPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 30060 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
MARIETTA, GA 30060
MARIETTA, GA 30060
MARIETTA, GA 30060
MARIETTA, GA 30060
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 Omar Lopez's NPI number?
The NPI number for Omar Lopez is 1164162889. It was assigned to this individual provider in the NPPES registry on March 30, 2022.
Where is Omar Lopez located?
Omar Lopez practices at 677 Church St NE, Marietta, GA 30060. The listed phone number is (864) 305-8237.
What is Omar Lopez's specialty?
The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.
Is Omar Lopez enrolled in Medicare?
Yes. Omar Lopez is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Omar Lopez's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Omar Lopez reassigns Medicare benefits to 2 organizations: The Bortolazzo Group, LLC (Austell, GA) and Acs Primary Care Physicians - Southeast PC (Myrtle Beach, SC). Each 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 Omar Lopez's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Omar Lopez affiliated with any hospitals?
According to CMS data, Omar Lopez is affiliated with Wellstar Kennestone Regional Medical Center, Piedmont Medical Center and Musc Medical Center.
When was this NPI record last updated?
The NPPES record for Omar Lopez was last updated on October 22, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months 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.
# Omar David Lopez · NPI 1164162889
Emergency Medicine physician in Marietta, Georgia. Individual provider, active in the CMS NPPES registry since March 30, 2022.
## Identity
- **NPI:** 1164162889 (Entity type: Individual)
- **Enumerated:** March 30, 2022
- **Primary specialty:** Emergency Medicine · taxonomy 207P00000X
- **State license:** 94179 (South Carolina)
- **Sole proprietor:** No
## Practice location
- **Address:** 677 CHURCH ST NE, Marietta, GA 30060-1101
- **Phone:** (864) 305-8237
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): The Bortolazzo Group, LLC (NPI 1801965082, Austell, GA); Acs Primary Care Physicians - Southeast PC (NPI 1861430555, Myrtle Beach, SC) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** University Of South Carolina School Of Medicine, class of 2022
## Record status
- **NPPES last updated:** October 22, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1164162889) · Data from the CMS NPPES public registry.