NPIMap

Individual provider Active NPI

Edith Hollie Odom

  • Family Nurse Practitioner
  • Myrtle Beach, SC
National Provider Identifier
1023760626
Registry record updated Jan 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
25801 Issued in SC
Practice address
106 Lansford PL # 100
Myrtle Beach, SC 29588-6979
Phone
(843) 293-8850
Fax
(843) 293-8860
NPI assigned
Jan 25, 2022
Last updated
Jan 12, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 25801 SC Primary

Addresses

Primary practice location

106 Lansford PL # 100
Myrtle Beach, SC 29588-6979

Mailing address

106 Lansford PL # 100
Myrtle Beach, SC 29588-6979
Phone (843) 293-8850

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
I20220307000259 SC Practitioner - Nurse Practitioner 8325384910 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Medicine of Sayebrook LLCGroup PAC ID 4789685256, 5 clinicians
SC House Calls IncGroup PAC ID 6800994807, 445 clinicians

Practice addresses (Care Compare)

106 Lansford CT
Suite 100
Myrtle Beach, SC 29588-3501
Phone (843) 293-8850

1400 Main St
Conway, SC 29526-3567
Phone (843) 488-0101

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
SC House Calls Inc CurrentSince Feb 8, 2022 Accepting new patients
Family Medicine of Sayebrook, LLC CurrentSince Jan 1, 2023 Accepting new patients
SC House Calls Inc CurrentSince Feb 8, 2022 Accepting new patients

Locations

1624 Main St
Columbia, SC 29201
Phone (803) 454-0365

1400 Main St
Conway, SC 29526
Phone (803) 248-7272

106 Lansford Ct
Ste 100
Myrtle Beach, SC 29588
Phone (843) 293-8850

1053 Center St
West Columbia, SC 29169
Phone (803) 454-0365

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HEHFAD
  • FHIR API: https://fhir4.healow.com/fhir/r4/HEHFAD/Endpoint/HEHFAD

Organizations & group practices 3

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 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1643068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673481600000",
    "number": "1023760626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 LANSFORD PL # 100",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295886979",
            "telephone_number": "843-293-8850",
            "fax_number": "843-293-8860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 LANSFORD PL # 100",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295886979",
            "telephone_number": "843-293-8850",
            "fax_number": "843-293-8860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODOM",
        "first_name": "EDITH",
        "middle_name": "HOLLIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-25",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "25801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.