NPIMap

Individual provider Active NPI

Odessa M Gallett, RDCD

  • Registered Dietitian
  • Medford, WI
National Provider Identifier
1245241272
Registry record updated Oct 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
1752 Issued in WI
Practice address
143 South Gibson Street
Medford, WI 54451-1622
Phone
(715) 748-2121
Fax
(715) 748-7590
NPI assigned
Aug 11, 2006
Last updated
Oct 13, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 1752 WI Primary

Addresses

Primary practice location

143 South Gibson Street
Medford, WI 54451-1622

Mailing address

143 South Gibson Street
Medford, WI 54451-1622
Phone (715) 748-2121

Other identifiers 1

IdentifierTypeStateIssuer
100531OtherWISECURITY HEALTH PLAN

Other names 1

  • Odessa M Syryczuk Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050805000443 WI Practitioner - Registered Dietitian Or Nutrition Professional 3870522253 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aspirus Medford Hospital and Clinics IncGroup PAC ID 5799688602, shared by 9 NPIs, 126 clinicians
Aspirus Stanley Hospital and Clinics IncGroup PAC ID 8325957095, shared by 6 NPIs, 34 clinicians

Practice addresses (Care Compare)

135 S Gibson St
Medford, WI 54451-1622
Phone (715) 748-8100

143 S Gibson St
Medford, WI 54451-1622
Phone (715) 748-8100

320 E Main St
Gilman, WI 54433-9674
Phone (715) 447-8293

6 Johnson St
Owen, WI 54460-9534
Phone (715) 229-2177

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
97.16
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1752WIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Stanley Hospital & Clinics, Inc. CurrentSince Sep 1, 2023 Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. CurrentSince May 31, 2016 Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. Current Accepting new patients
Aspirus Stanley Hospital & Clinics, Inc. CurrentSince Sep 1, 2023 Accepting new patients
Aspirus Stanley Hospital & Clinics, Inc CurrentSince Sep 1, 2023 Accepting new patients
Aspirus Medford Hospital & Clinics, Inc. Current Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

143 S Gibson St
Medford, WI 54451
Phone (715) 748-2121

1120 Pine St
Stanley, WI 54768
Phone (715) 644-5530

Organizations & group practices 6

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444694400000",
    "number": "1245241272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 SOUTH GIBSON STREET",
            "city": "MEDFORD",
            "state": "WI",
            "postal_code": "544511622",
            "telephone_number": "715-748-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 SOUTH GIBSON STREET",
            "city": "MEDFORD",
            "state": "WI",
            "postal_code": "544511622",
            "telephone_number": "715-748-2121",
            "fax_number": "715-748-7590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLETT",
        "first_name": "ODESSA",
        "middle_name": "M",
        "credential": "RDCD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-11",
        "last_updated": "2015-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WI",
            "license": "1752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SECURITY HEALTH PLAN",
            "identifier": "100531",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ODESSA",
            "last_name": "SYRYCZUK",
            "middle_name": "M",
            "credential": "RCDC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Medford, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.