NPIMap

Individual provider Active NPI

Douglas Lawrence O'Dea, M.D.

  • Internal Medicine Physician
  • Bartlett, TN
National Provider Identifier
1316974132
Registry record updated Oct 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD0000018194 Issued in TN
Practice address
7378 Yale Rd
Bartlett, TN 38133-3604
Phone
(901) 387-0193
Fax
(901) 387-0796
NPI assigned
Jun 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD0000018194 TN Primary

Addresses

Primary practice location

7378 Yale Rd
Bartlett, TN 38133-3604

Mailing address

PO Box 902, Dept 100
Memphis, TN 38101-0902
Phone (901) 757-2791

Other identifiers 2

IdentifierTypeStateIssuer
0108564OtherTNBLUECROSS OF TENNESSEE
3027190MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050225000467 TN Practitioner - Internal Medicine 3072406909 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Tennessee, HSC, College of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Internal Medicine, P. C.Group PAC ID 1355242959, 5 clinicians

Practice addresses (Care Compare)

7378 Yale Rd
Bartlett, TN 38133-3604
Phone (901) 387-0193

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
30.8 of 100Reported as individual
Quality
15
Improvement activities
0
Cost
82.67

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD0000018194TNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Internal Medicine, P. C. Internal Medicine CurrentSince Jun 1, 1990 Accepting new patients
Mid-South Ear, Nose, and Throat, P.C. PastSince Apr 17, 2017 Accepting new patients

Locations

7378 Yale Rd
Bartlett, TN 38133
Phone (901) 387-0193

Organizations & group practices 2

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.

Hospital & facility affiliations 11

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": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351641600000",
    "number": "1316974132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 902, DEPT 100",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381010902",
            "telephone_number": "901-757-2791",
            "fax_number": "901-757-9065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7378 YALE RD",
            "city": "BARTLETT",
            "state": "TN",
            "postal_code": "381333604",
            "telephone_number": "901-387-0193",
            "fax_number": "901-387-0796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'DEA",
        "first_name": "DOUGLAS",
        "middle_name": "LAWRENCE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2012-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "MD0000018194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS OF TENNESSEE",
            "identifier": "0108564",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3027190",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bartlett, TN

Sources for this page

Verify at the official NPI Registry.