NPIMap

Individual provider Active NPI

John N Odom, MD

  • Family Medicine Physician
  • Mullins, SC
National Provider Identifier
1003889387
Registry record updated Mar 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
16250 Issued in SC
Practice address
3032 E Highway 76
Mullins, SC 29574-7396
Phone
(843) 292-7331
Fax
(843) 292-7324
NPI assigned
Feb 8, 2006
Last updated
Mar 26, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 16250 SC Primary

Addresses

Primary practice location

3032 E Highway 76
Mullins, SC 29574-7396

Mailing address

PO Box 3239
Florence, SC 29502-3239
Phone (843) 292-7331

Other identifiers 1

IdentifierTypeStateIssuer
T10501MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031119000535 SC Practitioner - Family Practice 5597679852 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical University of South Carolina College of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McLeod Health CherawGroup PAC ID 7911228259, 35 clinicians

Practice addresses (Care Compare)

3032 E Hwy 76
Mullins, SC 29574-7396
Phone (843) 464-7111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
McLeod Health Cheraw Family Medicine CurrentSince Apr 23, 2020 Accepting new patients
McLeod Health Cheraw Current Accepting new patients
McLeod Health Cheraw Family Medicine CurrentSince Apr 23, 2020 Accepting new patients
McLeod Physician Associates, Inc Family Medicine Past Accepting new patients

Locations

711 Chesterfield Hwy
Cheraw, SC 29520
Phone (843) 320-3304

3032 E Highway 76
Mullins, SC 29574
Phone (843) 292-7300

Interoperability endpoints

  • Direct secure messaging: jodom19178@directmcleodehealth.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238025600000",
    "number": "1003889387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3239",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295023239",
            "telephone_number": "843-292-7331",
            "fax_number": "843-292-7324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3032 E HIGHWAY 76",
            "city": "MULLINS",
            "state": "SC",
            "postal_code": "295747396",
            "telephone_number": "843-292-7331",
            "fax_number": "843-292-7324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODOM",
        "first_name": "JOHN",
        "middle_name": "N",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2009-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "16250",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T10501",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mullins, SC

Sources for this page

Verify at the official NPI Registry.