Ebenezer Kofi Bentum Odoom, MD

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

230787 Issued in NY

Practice address

21530 Hillside Ave
Queens Village, NY 11427-1831

Phone

(718) 740-1701

Fax

(718) 740-1901

NPI assigned

Oct 3, 2006

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 NY

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

Internal MedicineAlso: Geriatric Medicine, Pediatric Medicine

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Primary Partnercare Physicians PLLCGroup PAC ID 9638593585, 18 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359

Interoperability endpoints

• Direct secure messaging: ebenezer.odoom.1@24863.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/24863/brand/1/csg/1/fhir/r4

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.

• Primary Partnercare Physicians PLLC

  • Internal Medicine Physician
  • New Hyde Park, NY
  • NPI 1891318168
  Medicare reassignment Care Compare group NPD
• Rosedale Medical Office,PLLC

  • Internal Medicine Physician
  • Rosedale, NY
  • NPI 1871788877
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1154416691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 NORTHERN BLVD STE 328",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215329",
            "telephone_number": "516-233-2484",
            "fax_number": "516-304-5850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21530 HILLSIDE AVE",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114271831",
            "telephone_number": "718-740-1701",
            "fax_number": "718-740-1901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODOOM",
        "first_name": "EBENEZER",
        "middle_name": "KOFI BENTUM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NY",
            "license": "230787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nyus Equipments LLC
• Oasis Medical Care PC
• Rosemary Obaze-Anyene
• Chinwendu N. Obijuru, MD
• Cheryl Oden
• Abieyuwa Ogbeta, RN
• Lucia Magdalena Ohuche, LCSW
• Francis A. Ojiezele, RN
• Tawana Nicole Okene, REGISTERED NURSE(RN)
• Patricia Ngozi Okoye-Oyibo

• Geriatric Medicine (Internal Medicine) Physician in Queens Village, NY
• Providers in Queens Village, NY by specialty
• Geriatric Medicine (Internal Medicine) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 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.