Otar Datiashvili, MD in Bloomington, IN - Medicare Emergency Medicine

Otar Datiashvili, MD is a medicare enrolled "Emergency Medicine" physician in Bloomington, Indiana. He went to State University Of New York At Stony Brook, School Of Medicine and graduated in 2008 and has 17 years of diverse experience with area of expertise as Emergency Medicine. He is a member of the group practice Olive Branch Emergency Physicians Llc, Indiana University Health Southern Indiana Physicians Llc, Methodist South Emergency Physicians, Pllc and his current practice location is 2651 E Discovery Pkwy, Bloomington, Indiana. You can reach out to his office (for appointments etc.) via phone at (812) 353-9515.

Otar Datiashvili is licensed to practice in Indiana (license number 01093706A) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1083096572.

Contact Information

	Otar Datiashvili, MD
	2651 E Discovery Pkwy, Bloomington, IN 47408-9059
	(812) 353-9515
	(812) 353-9275

Map and Direction

Physician's Profile

Full Name	Otar Datiashvili
Gender	Male
Speciality	Emergency Medicine
Experience	17 Years
Location	2651 E Discovery Pkwy, Bloomington, Indiana
Accepts Medicare Assignments	Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Otar Datiashvili attended and graduated from State University Of New York At Stony Brook, School Of Medicine in 2008

NPI Data:

NPI Number: 1083096572
Provider Enumeration Date: 06/22/2015
Last Update Date: 03/05/2025

Medicare PECOS Information:

PECOS PAC ID: 3678882214
Enrollment ID: I20160316000892

Medical Identifiers

Medical identifiers for Otar Datiashvili such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1083096572	NPI	-	NPPES
03782025	Medicaid	IN

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207P00000X	Emergency Medicine	01093706A (Indiana)	Primary
207P00000X	Emergency Medicine	273598-1 (New York)	Secondary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
Suny/stony Brook University Hospital	Stony brook, NY	Hospital
Indiana University Health Paoli Hospital	Paoli, IN	Hospital
Methodist Healthcare - Olive Branch Hospital	Olive branch, MS	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Olive Branch Emergency Physicians Llc	9335598739	25
Indiana University Health Southern Indiana Physicians Llc	6204748197	461
Methodist South Emergency Physicians, Pllc	6406205608	42

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Otar Datiashvili allows following entities to bill medicare on his behalf.

Entity Name	Olive Branch Emergency Physicians Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1730969734 PECOS PAC ID: 9335598739 Enrollment ID: O20231211002611

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Otar Datiashvili is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Otar Datiashvili, MD 250 N Shadeland Ave, Indianapolis, IN 46219-4959 Ph: () -	Otar Datiashvili, MD 2651 E Discovery Pkwy, Bloomington, IN 47408-9059 Ph: (812) 353-9515

Reviews and Comments

Emergency Medicine Doctors in Bloomington, IN

Ronald C Jenson, DO Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 4794 Red Oak Ln, Bloomington, IN 47401 Phone: 812-396-9620
Dr. Robert Stone, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 514 W 2nd St, Bloomington, IN 47403 Phone: 812-353-3719 Fax: 812-353-3713
Dr. Christina M Cabott, DO Emergency Medicine Medicare: Medicare Enrolled Practice Location: 601 W 2nd St, Bloomington, IN 47403 Phone: 812-336-1690 Fax: 812-349-1325
Dr. John Austin Lee, MD, MPH Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 2651 E Discovery Pkwy, Bloomington, IN 47408 Phone: 812-353-9515 Fax: 812-353-9275
Dr. Carlyle George Langhorn Jr., M.D. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 2651 E Discovery Pkwy, Bloomington, IN 47408 Phone: 812-353-9515
Jonathan D Hart, M.D. Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 2605 E Creeks Edge Dr, Bloomington, IN 47401 Phone: 812-355-2300 Fax: 812-355-2316

Otar Datiashvili, MD - Medicare Emergency Medicine in Bloomington, IN