Dianna Odom, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

2933 Lakewood Village Dr
North Little Rock, AR 72116-8033

Phone

(501) 435-1417

NPI assigned

Feb 2, 2021

Last updated

Jul 2, 2024By the provider in NPPES

Sex

Female

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 AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

University of Arkansas College of Medicine, 2020

Medicare assignment

May accept Medicare assignment

Group practices

Oak Street Health Physicians Group of Arkansas PLLCGroup PAC ID 2264893411, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Oak Street Health Physicians Group of Arkansas PLLC

  • Primary Care Clinic/Center
  • Little Rock, AR
  • NPI 1144917758
  Medicare reassignment Care Compare group
• St Mary's Physician Services LLC

  • General Practice Physician
  • Russellville, AR
  • NPI 1124084991
  Medicare reassignment NPD
• St Marys Physician Services, LLC

  • Durable Medical Equipment & Medical Supplies
  • Russellville, AR
  • NPI 1063626117
  NPD

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

{
    "created_epoch": "1612224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719878400000",
    "number": "1104417021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 MOHAWK CIR",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722072515",
            "telephone_number": "479-970-4064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2933 LAKEWOOD VILLAGE DR",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721168033",
            "telephone_number": "501-435-1417"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1808 W Main St",
            "address_purpose": "LOCATION",
            "city": "Russellville",
            "state": "AR",
            "postal_code": "728012724",
            "country_code": "US",
            "telephone_number": "479-968-2841",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3140 AR-5",
            "address_purpose": "LOCATION",
            "city": "Bryant",
            "state": "AR",
            "postal_code": "72019",
            "country_code": "US",
            "telephone_number": "501-213-4500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ODOM",
        "first_name": "DIANNA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-02",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oak Grove Pharmacy Inc (Oak Grove Pharmacy)
• Oak Grove Pharmacy JFK Inc (Medicine Man Pharmacy JFK)
• Natalia Obraztsova, MD
• Occupational Health Centers of Arkansas, P.a. (Concentra Medical Center)
• Paige Oden
• Megan Ogle
• Jacqueline Oh
• Karen Renee Okeefe, RDN, LD
• Darlene N/a Okeke, LPN
• Ronald Okolichany, PSYD

• Physician Assistant in North Little Rock, AR
• Providers in North Little Rock, AR by specialty
• Physician Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2024; 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.