Keith J. Odegard, MD

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

2004027795 Issued in MO

Practice address

12855 North Forty Drive
Suite 125
St. Louis, MO 63141

Phone

(314) 966-0111

Fax

(314) 966-1023

NPI assigned

Sep 20, 2005

Last updated

Oct 21, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

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

Specialty

Orthopedic Surgery

Education

University of Minnesota Medical School, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Arnold Physical Therapy and Sports Medicine LLCGroup PAC ID 5698803278, 87 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kodegard99558@directc.mercy.net

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.

• Mercy Clinic Surgical Specialists, LLC

  • Vascular Surgery Physician
  • Washington, MO
  • NPI 1043530538
  Medicare reassignment NPD
• Mercy Hospitals East Communities

  dba Mercy JFK Clinic

  • Clinic/Center
  • Saint Louis, MO
  • NPI 1851431738
  Medicare reassignment NPD
• St Louis Orthopedic Institute Inc

  • Orthopaedic Surgery Physician
  • Saint Louis, MO
  • NPI 1881707644
  Authorized official Same address or phone
• Arnold Physical Therapy & Sports Medicine LLC

  • Rehabilitation Clinic/Center
  • Arnold, MO
  • NPI 1639400179
  Care Compare group
• Mercy Hospitals East Communities

  dba Mercy St. Louis Transport Ambulance

  • Land Ambulance
  • Saint Louis, MO
  • NPI 1881329902
  NPD
• Ozarks Medical Center

  dba Ozarks Healthcare

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319155200000",
    "number": "1083609614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12813 FLUSHING MEADOWS DRIVE",
            "address_2": "SUITE 210",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "63131",
            "telephone_number": "314-966-0111",
            "fax_number": "314-966-1023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12855 NORTH FORTY DRIVE",
            "address_2": "SUITE 125",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "63141",
            "telephone_number": "314-966-0111",
            "fax_number": "314-966-1023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODEGARD",
        "first_name": "KEITH",
        "middle_name": "J.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2011-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MO",
            "license": "2004027795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin M Oconnor, MD
• Matthew Brady Oconnor, LPC
• Michaela Oconnor
• Andrew John Odden, MD
• Dean Thomas Odegard, MD
• Rebecca Kathleen Odegard, CCC-SLP
• Rachel Lauren Odehnal
• Michael J Odell, MD
• Randall R Odem, MD
• Judith Odendahl

• Orthopaedic Surgery Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Orthopaedic Surgery Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2011; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.