Individual provider Active NPI

Ann E Odonnell, D.O.

  • Internal Medicine Physician
  • Davenport, IA
National Provider Identifier
1376522243
Registry record updated Jun 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
03020 Issued in IA
Practice address
1820 W 3Rd St
Davenport, IA 52802-1812
Phone
(563) 326-1661
Fax
(563) 326-1901
NPI assigned
Jan 10, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 2, 2021

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 03020 IA Primary

Addresses

Primary practice location

1820 W 3Rd St
Davenport, IA 52802-1812

Mailing address

1820 W 3Rd St
Davenport, IA 52802-1812
Phone (563) 326-1661

Other identifiers 1

IdentifierTypeStateIssuer
5163295MedicaidIA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ann.odonnell@direct.genesishealth.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100717000184 IA Practitioner - Internal MedicinePractitioner - Family Practice 0244281335 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
03020IAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Health System CurrentSince Oct 1, 2019 Accepting new patients
Davenport Clinic, P.C. CurrentSince Jan 16, 2006 Accepting new patients
Genesis Health System Internal Medicine CurrentSince Oct 1, 2019 Accepting new patients

Locations

2546 Tech Dr
Bettendorf, IA 52722
Phone (563) 421-5400

865 Lincoln Rd
Ste 100
Bettendorf, IA 52722
Phone (563) 355-1000

4700 E 56th St
Ste 100
Davenport, IA 52807
Phone (563) 383-2667

1351 W Central Park Ave
Ste 340
Davenport, IA 52804
Phone (563) 421-1287

1820 W 3rd St
Davenport, IA 52802
Phone (563) 326-1661

Interoperability endpoints

  • Direct secure messaging: ann.odonnell@direct.genesishealth.com

Organizations & group practices 3

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": "1136851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622592000000",
    "number": "1376522243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 W 3RD ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528021812",
            "telephone_number": "563-326-1661",
            "fax_number": "563-326-1901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1820 W 3RD ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528021812",
            "telephone_number": "563-326-1661",
            "fax_number": "563-326-1901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODONNELL",
        "first_name": "ANN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-10",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "03020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5163295",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ann.odonnell@direct.genesishealth.com",
            "affiliation": "N",
            "endpointDescription": "Genesis Health System Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "2546 Tech Dr",
            "city": "Bettendorf",
            "state": "IA",
            "country_code": "US",
            "postal_code": "527223345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.