Jennifer Oddleifson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA289 Issued in ME

Practice address

592 West Main St.-
Waldoboro, ME 04572-6030

Phone

(207) 832-6394

Fax

(207) 832-4392

NPI assigned

Aug 2, 2005

Last updated

Feb 20, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: joddleifson1029@direct.mmc.mainehealth.org

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.

• Mainehealth

  dba MaineHealth Pharmacy Brighton Ave

  • Community/Retail Pharmacy
  • Portland, ME
  • NPI 1013868181
  NPD
• Mainehealth

  • Gynecology Physician
  • South Portland, ME
  • NPI 1679887400
  NPD

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392854400000",
    "number": "1013918036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 745",
            "city": "NEWCASTLE",
            "state": "ME",
            "postal_code": "045530745",
            "telephone_number": "207-563-4511",
            "fax_number": "207-563-4103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "592 WEST MAIN ST.-",
            "city": "WALDOBORO",
            "state": "ME",
            "postal_code": "045726030",
            "telephone_number": "207-832-6394",
            "fax_number": "207-832-4392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODDLEIFSON",
        "first_name": "JENNIFER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-02",
        "last_updated": "2014-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA - 289",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290260099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ted R Mohlie, M.D.
• Msad 40
• Stacy Lee Nash, LMT
• Chuong Nguyen
• Kathleen M Ocean, LMT
• Francine Vongphet Olney, FNP
• Laurel L Reever, FNP
• Devon Elizabeth Riley, FNP-C
• Julie Ayer Rogers, LMT
• Helen Charlotte Catherine Russell

• Physician Assistant in Waldoboro, ME
• Providers in Waldoboro, ME by specialty
• Physician Assistant in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.