Individual provider Active NPI

Cori Michaela Odwak, MD

  • Family Medicine Physician
  • Erie, PA
National Provider Identifier
1215616065
Registry record updated Jul 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MT229960 Issued in PA
Practice address
232 W 25TH St
Erie, PA 16544-0002
Phone
(814) 452-5000
NPI assigned
Jul 17, 2023
Last updated
Jul 17, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MT229960 PA Primary

Addresses

Primary practice location

232 W 25TH St
Erie, PA 16544-0002

Mailing address

311 W 24TH St FL 4
Erie, PA 16502-2665
Phone (814) 452-5105

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20260529003186 NC Practitioner - Family Practice 6608346713

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

PO Box
Suite 25016
Dallas, TX 75225

PO Box
Suite 25016
Dallas, TX 75225-1016

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT229960PAMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1689552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689552000000",
    "number": "1215616065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 W 24TH ST FL 4",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165022665",
            "telephone_number": "814-452-5105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 W 25TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165440002",
            "telephone_number": "814-452-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODWAK",
        "first_name": "CORI",
        "middle_name": "MICHAELA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-17",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MT229960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.