Individual provider Active NPI

John Thornton O'Donnell, M.D.

  • Psychiatry Physician
  • Fort Myers, FL
National Provider Identifier
1205890282
Registry record updated Jan 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
158850 Issued in NY
Practice address
11215 Metro Pkwy Ste 1
Fort Myers, FL 33966-1206
Phone
(239) 208-2212
NPI assigned
Apr 14, 2006
Last updated
Jan 5, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Psychiatry & Neurology) Physician 2084A0401X 158850 NY
Addiction Medicine (Psychiatry & Neurology) Physician 2084A0401X MA059107 NJ
Psychiatry Physician 2084P0800X 158850 NY Primary
Psychiatry Physician 2084P0800X MA059107 NJ

Addresses

Primary practice location

11215 Metro Pkwy Ste 1
Fort Myers, FL 33966-1206

Mailing address

11215 Metro Pkwy Ste 1
Fort Myers, FL 33966-1206
Phone (239) 208-2212

Other practice location 1

21 Chittenden Ave Apt 3
New York, NY 10033-1101
Phone (212) 688-7088

Other identifiers 1

IdentifierTypeStateIssuer
6359205MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MA059107NJMDAddiction Medicine (Psychiatry & Neurology) Physician
158850NYMDAddiction Medicine (Psychiatry & Neurology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nys Office of Mental Health Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672876800000",
    "number": "1205890282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11215 METRO PKWY STE 1",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339661206",
            "telephone_number": "239-208-2212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11215 METRO PKWY STE 1",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339661206",
            "telephone_number": "239-208-2212"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21 Chittenden Ave Apt 3",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100331101",
            "country_code": "US",
            "telephone_number": "212-688-7088",
            "fax_number": "212-923-3284",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "O'DONNELL",
        "first_name": "JOHN",
        "middle_name": "THORNTON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "NY",
            "license": "158850",
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "NJ",
            "license": "MA059107",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "158850",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "MA059107",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6359205",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.