Individual provider Active NPI

Othell Raven

  • Case Manager/Care Coordinator
  • Albany, GA
National Provider Identifier
1316734791
Registry record updated Apr 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Practice address
1319 W Broad Ave
Albany, GA 31707-4343
Phone
(229) 496-9147
Fax
(229) 496-9258
NPI assigned
Apr 21, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Personal Care Attendant 3747P1801X
Home Health Aide 374U00000X
Nurse's Aide 376K00000X
Case Manager/Care Coordinator 171M00000X Primary

Addresses

Primary practice location

1319 W Broad Ave
Albany, GA 31707-4343

Mailing address

1319 W Broad Ave
Albany, GA 31707-4343
Phone (229) 496-9147

Other practice location 1

6605 Abercorn St Ste 105A
Savannah, GA 31405-5896
Phone (229) 496-9147

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ventures LLC CurrentSince Apr 27, 2025 Accepting new patients

Locations

1319 W Broad Ave
Albany, GA 31707
Phone (229) 496-9147

6605 Abercorn St
Ste 105A
Savannah, GA 31405
Phone (229) 496-9147

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1745193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745193600000",
    "number": "1316734791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1319 W BROAD AVE",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317074343",
            "telephone_number": "229-496-9147",
            "fax_number": "229-496-9258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1319 W BROAD AVE",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317074343",
            "telephone_number": "229-496-9147",
            "fax_number": "229-496-9258"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6605 Abercorn St Ste 105A",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314055896",
            "country_code": "US",
            "telephone_number": "229-496-9147",
            "fax_number": "229-496-9258",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAVEN",
        "first_name": "OTHELL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-04-21",
        "last_updated": "2025-04-21",
        "certification_date": "2025-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.