NPIMap

Organization Active NPI

Odyssey Urgent Care and Occupational Health

  • Urgent Care Clinic/Center
  • Kenai, AK
National Provider Identifier
1265203160
Registry record updated Jun 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
ODYSSEY URGENT CARE AND OCCUPATIONAL HEALTH
Practice address
Odyssey Family Practice LLC
11595 Kenai Spur Hwy
Kenai, AK 99611
Phone
(907) 313-4569
Fax
(907) 313-4939
NPI assigned
Jan 10, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2024

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

Authorized official

Name
Mr. Jared L WallaceNPI 1063746667
Title
Managing Member
Phone
(907) 313-4569

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

Odyssey Family Practice LLC
11595 Kenai Spur Hwy
Kenai, AK 99611

Mailing address

Odyssey Urgent Care and Occupational Health
11595 Kenai Spur Hwy
Kenai, AK 99611
Phone (907) 313-5432

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200129002758 AK Part B Supplier - Clinic/Group Practice 3476989062 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kenai, AK
O20240709004806 AK Part B Supplier - Clinic/Group Practice 2264977636 Receives reassigned benefits from 4 practitioners
Practice locations: Kenai, AK

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

11595 Kenai Spur Hwy
#B
Kenai, AK 99611
Phone (907) 313-4569

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1704844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718668800000",
    "number": "1265203160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ODYSSEY URGENT CARE AND OCCUPATIONAL HEALTH",
            "address_2": "11595 KENAI SPUR HWY",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "99611",
            "telephone_number": "907-313-5432",
            "fax_number": "907-313-4939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ODYSSEY FAMILY PRACTICE LLC",
            "address_2": "11595 KENAI SPUR HWY",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "99611",
            "telephone_number": "907-313-4569",
            "fax_number": "907-313-4939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ODYSSEY URGENT CARE AND OCCUPATIONAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-10",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-11",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "JARED",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "907-313-4569",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenai, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; 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.