Individual provider Active NPI

Ian Odgear, AU.D.

  • Audiologist
  • Bend, OR
National Provider Identifier
1225488786
Registry record updated Jun 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
030857 Issued in OR
Practice address
2205 NW Shevlin Park Rd
Bend, OR 97703-7195
Phone
(541) 678-5698
NPI assigned
Jun 15, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 030857 OR Primary

Addresses

Primary practice location

2205 NW Shevlin Park Rd
Bend, OR 97703-7195

Mailing address

2205 NW Shevlin Park Rd
Bend, OR 97703-7195
Phone (541) 678-5698

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170412001264 OR Practitioner - Qualified Audiologist 0042596744 Reassigns benefits to 1 organization
I20181113000809 WA Practitioner - Qualified Audiologist 0042596744 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
030857ORMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Zimmerman Group, LLC Audiologist CurrentSince Nov 16, 2021 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Sep 10, 2018 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Sep 10, 2018 Accepting new patients

Locations

2205 NW Shevlin Park Rd
Bend, OR 97703
Phone (541) 678-5698

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

7101 NE 137th Ave
Ofc
Vancouver, WA 98682
Phone (360) 944-2700

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1465948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465948800000",
    "number": "1225488786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 NW SHEVLIN PARK RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977037195",
            "telephone_number": "541-678-5698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2205 NW SHEVLIN PARK RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977037195",
            "telephone_number": "541-678-5698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODGEAR",
        "first_name": "IAN",
        "name_prefix": "Dr.",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-15",
        "last_updated": "2016-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "OR",
            "license": "030857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.