Annie D Odom

Primary specialty

Home Health AideTaxonomy code 374U00000X

License

115567 Issued in FL

Practice address

2257 Clara Kee Blvd
Tallahassee, FL 32303-7135

Phone

(850) 405-0109

NPI assigned

Feb 26, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Imperial Guardian LLC

  • Home Health Aide
  • Tallahassee, FL
  • NPI 1962112060
  NPD Authorized official

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

{
    "created_epoch": "1582675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1043844202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2413 RAYMOND DIEHL RD APT 2",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323093628",
            "telephone_number": "850-692-4300",
            "fax_number": "850-668-8329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2257 CLARA KEE BLVD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323037135",
            "telephone_number": "850-405-0109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODOM",
        "first_name": "ANNIE",
        "middle_name": "D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-26",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": "FL",
            "license": "115567",
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": "FL",
            "license": "235755",
            "primary": false
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "FL",
            "license": "115567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "012409200",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39970618",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115567",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Jason Oberste, M.D.
• Walter Lawrence Ochalek, PHARMD
• Octave Behavioral PA
• Emmie Odham, APRN
• Kathy Odham, ARNP
• Aria' Odom
• Maili Odom
• Jennifer Oetting, APRN
• Judy A Ognibene, M.D.
• Olusola Ogunjobi

• Home Health Aide in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Home Health Aide in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.