Active NPI
Randall R Odem, MD
- Reproductive Endocrinology Physician
- Saint Louis, MO
National Provider Identifier
1336165554
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Reproductive Endocrinology Physician
- License
- R7E33
- Practice address
- 4444 Forest Park Ave Ste 3100
Ste 3100
Saint Louis, MO 63108-2212 - Phone
- (314) 286-2400
- Fax
- (314) 286-2455
- NPI assigned
- Jul 14, 2006
- Last updated
- Nov 27, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Reproductive Endocrinology Physician | 207VE0102X | R7E33 | MO | Primary |
Addresses
Primary practice location
4444 Forest Park Ave Ste 3100
Ste 3100
Saint Louis, MO 63108-2212
Mailing address
660 S Euclid Ave
C B 8064
Saint Louis, MO 63110-1010
Phone (314) 286-2400
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 202236402 | Medicaid | MO | |
| ENROLLED | Medicaid | IL |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | obgynbillings@wudosis.wustl.edu | Other | Washington University |
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)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- rodem154790@direct.carenet.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701043200000",
"number": "1336165554",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "660 S EUCLID AVE",
"address_2": "C B 8064",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631101010",
"telephone_number": "314-286-2400",
"fax_number": "314-286-2455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4444 FOREST PARK AVE STE 3100",
"address_2": "STE 3100",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631082212",
"telephone_number": "314-286-2400",
"fax_number": "314-286-2455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODEM",
"first_name": "RANDALL",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-14",
"last_updated": "2023-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "207VE0102X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Reproductive Endocrinology",
"state": "MO",
"license": "R7E33",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "202236402",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ENROLLED",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "obgynbillings@wudosis.wustl.edu",
"affiliation": "Y",
"endpointDescription": "Washington University",
"affiliationName": "Washington University",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "660 S Euclid Ave",
"city": "Saint Louis",
"state": "MO",
"country_code": "US",
"postal_code": "631101010",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.