Active NPI
Clementine S Odamtten, NP
- Family Medicine Physician
- San Jose, CA
National Provider Identifier
1104340306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 95006909
- Practice address
- 2498 Stevens Creek Blvd
San Jose, CA 95128-1652 - Phone
- (408) 998-5400
- Fax
- (408) 998-5414
- NPI assigned
- Jul 28, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 95006909 | CA | Primary |
Addresses
Primary practice location
2498 Stevens Creek Blvd
San Jose, CA 95128-1652
Mailing address
308 Shaughnessy Dr
Milpitas, CA 95035-5474
Phone (571) 524-6265
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| VST Medical | Current | Accepting new patients | |
| Zenmedicine | Current | Accepting new patients | |
| Vicrumdeep S Tung MD Inc | Current | Accepting new patients | |
| Clinical Mobile Care | Current | Accepting new patients |
Locations
741 S Orange Ave
Ste 100
West Covina, CA 91790
Phone (626) 338-5581
Interoperability endpoints
- clementine.odamtten@49412312072196.direct.elationemr.com
Organizations & group practices 4
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1501200000000",
"number": "1104340306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "308 SHAUGHNESSY DR",
"city": "MILPITAS",
"state": "CA",
"postal_code": "950355474",
"telephone_number": "571-524-6265"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2498 STEVENS CREEK BLVD",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951281652",
"telephone_number": "408-998-5400",
"fax_number": "408-998-5414"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODAMTTEN",
"first_name": "CLEMENTINE",
"middle_name": "S",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-28",
"last_updated": "2017-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "95006909",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2017; 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.