Debra Sue Odom, P.A.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

1340 Issued in OK

Practice address

1717A S Utica Ave
Tulsa, OK 74104

Phone

(918) 748-1300

Fax

(918) 748-1303

NPI assigned

May 2, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Debra Sue Warren Former name

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southside Dermatology PLLCGroup PAC ID 9234487554, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00426

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.

• Southside Dermatology PLLC

  • Dermatology Physician
  • Tulsa, OK
  • NPI 1750877072
  Medicare reassignment Care Compare group
• Southside Dermatology PLLC

  • Dermatology Physician
  • Broken Arrow, OK
  • NPI 1073263380
  NPD
• St. John Physicians, Inc

  • Rural Health Clinic/Center
  • Coffeyville, KS
  • NPI 1669792818
  NPD
• Carlos Gomez-Meade DO PC

  • MOHS-Micrographic Surgery Physician
  • Tulsa, OK
  • NPI 1245097948
  NPD (past)
• St. John Physicians, Inc.

  • Internal Medicine Physician
  • Tulsa, OK
  • NPI 1336194406
  NPD (past)
• Steven a. Smith, M.D., Dermatology, P.C.

  • Dermatology Physician
  • Tulsa, OK
  • NPI 1710900097
  NPD (past)

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389139200000",
    "number": "1316905110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717A S UTICA AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "74104",
            "telephone_number": "918-748-1300",
            "fax_number": "918-748-1303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717A S UTICA AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "74104",
            "telephone_number": "918-748-1300",
            "fax_number": "918-748-1303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODOM",
        "first_name": "DEBRA",
        "middle_name": "SUE",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-02",
        "last_updated": "2014-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OK",
            "license": "1340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200023180A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEBRA",
            "last_name": "WARREN",
            "middle_name": "SUE",
            "credential": "P.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Olivia Raye Ochoa, PHARMD
• Ochsner Chiropractic Centre, PC
• Kayla Oconnor, LMSW
• Cynthia Ann Odle, PT
• Alexa Lee Odom
• Erik Odom, DO
• Leanne Odom, PA-C
• Sharon Denise Odom, CRNA
• Odyssey Counseling PLLC
• Jayne Rhea Oertle, RN, CNS

• Medical Physician Assistant in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Medical Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.