David Devaul Odineal, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

65771 Issued in TN

Practice address

7973 W Destiny Blvd
Fort Campbell, KY 42223-5429

Phone

(270) 798-4677

NPI assigned

Jun 28, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• App of Tennessee HM, PLLC

  • Hospitalist Physician
  • Shelbyville, TN
  • NPI 1396160768
  Medicare reassignment NPD
• Southeastern Physician Services PC

  • Hospitalist Physician
  • Oak Ridge, TN
  • NPI 1083835441

  Internal Medicine

  Medicare reassignment NPD

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

{
    "created_epoch": "1498608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663545600000",
    "number": "1023539160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7973 W DESTINY BLVD",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235429",
            "telephone_number": "270-798-4677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7973 W DESTINY BLVD",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235429",
            "telephone_number": "270-798-4677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODINEAL",
        "first_name": "DAVID",
        "middle_name": "DEVAUL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-28",
        "last_updated": "2022-09-19",
        "certification_date": "2022-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WI",
            "license": "7462220",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "65771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Nunn
• Laura Evangeline Barefoot O'Donnell, RN, CMGT-BC
• Melodie Lee O'Malley, RN
• Sharon S. O'Quinn, CRN, ARNP
• Michael Oates, DPT, OCS
• Barbara Oland, FNP-C
• Daniela Oranday
• Sandra Orange, EFDA
• Fernando Edmund Ordaz, M.D.
• Justin Orton, PSY.D., ABPP

• Internal Medicine Physician in Fort Campbell, KY
• Providers in Fort Campbell, KY by specialty
• Internal Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2022; 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.