NPIMap

Individual provider Active NPI

Bryan Keith Oditt, APA-C

  • Medical Physician Assistant
  • New London, CT
National Provider Identifier
1023096237
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
001247 Issued in CT
Practice address
15 Mohegan Ave
New London, CT 06320-8100
Phone
(860) 444-8207
Fax
(860) 444-8413
NPI assigned
Jan 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA11519 TX
Medical Physician Assistant 363AM0700X 001247 CT Primary

Addresses

Primary practice location

15 Mohegan Ave
New London, CT 06320-8100

Mailing address

15 Mohegan Ave
New London, CT 06320-8100
Phone (860) 444-8207

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20171201002680 TX Practitioner - Physician Assistant 5395068951 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hospital Medicine Services of TX, PLLCGroup PAC ID 3274998067, 376 clinicians
Transitional Care Physicians PLLCGroup PAC ID 3779996590, 43 clinicians

Practice addresses (Care Compare)

1139 E Sonterra Blvd
San Antonio, TX 78258-4347
Phone (210) 638-2000

4553 N Loop 1604
Suite 1119
San Antonio, TX 78249-1364
Phone (210) 741-8782

7700 Floyd Curl Dr
San Antonio, TX 78229-3902
Phone (210) 575-4000

Hospital & facility affiliations

  • Methodist Hospital Stone Oak Hospital, San Antonio, TX, CCN 670055
  • Methodist Hospital Hospital, San Antonio, TX, CCN 450388
  • University Health System Hospital, San Antonio, TX, CCN 450213

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA11519TXMDPhysician Assistant
001247CTMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Transitional Care Physicians PLLC CurrentSince Oct 6, 2025 Accepting new patients
Flycatcher Inpatient Services, LLC Past Accepting new patients

Locations

4553 N Loop 1604 W
Ste 1119
San Antonio, TX 78249
Phone (210) 741-8782

7700 Floyd Curl Dr
San Antonio, TX 78229
Phone (210) 575-5564

Organizations & group practices 5

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

Hospital & facility affiliations 5

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": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1023096237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 MOHEGAN AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063208100",
            "telephone_number": "860-444-8207",
            "fax_number": "860-444-8413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 MOHEGAN AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063208100",
            "telephone_number": "860-444-8207",
            "fax_number": "860-444-8413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODITT",
        "first_name": "BRYAN",
        "middle_name": "KEITH",
        "name_prefix": "Mr.",
        "credential": "APA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-06",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA11519",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "001247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New London, CT

Sources for this page

Verify at the official NPI Registry.