NPIMap

Organization Active NPI

Odyssey House Inc

Doing business as Odyssey House Martindale Clinic

  • Family Medicine Physician
  • Salt Lake City, UT
National Provider Identifier
1407481245
Registry record updated Mar 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ODYSSEY HOUSE INC
Doing business as
Odyssey House Martindale Clinic
Practice address
743 E 300 S
Salt Lake City, UT 84102
Phone
(801) 428-3500
Fax
(801) 210-5031
NPI assigned
Mar 11, 2020
Last updated
Mar 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2020

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

Authorized official

Name
Adam Cohen
Title
Ceo
Phone
(801) 428-3449

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Addiction Medicine (Family Medicine) Physician 207QA0401X NU

Addresses

Primary practice location

743 E 300 S
Salt Lake City, UT 84102

Mailing address

344 E 100 S Ste 301
Salt Lake City, UT 84111-1727
Phone (801) 322-4257

Other names 1

  • Odyssey House Martindale Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060222000116 UT Part B Supplier - Clinic/Group Practice 2365458833 Receives reassigned benefits from 29 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Salt Lake City, UT; West Valley City, UT; Murray, UT

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D2017040Odyssey House - Martindale Clinic743 East 300 South, Salt Lake City, UT 84102Certificate of waiverDec 1, 2026

National Provider Directory

National Provider Directory

Locations

68 S 600 E
Slc, UT 84102
Phone (801) 322-1001

2411 S 1070 W
Ste A
West Valley City, UT 84119
Phone (385) 271-1017

Practitioners & affiliated clinicians

Practitioners 35

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1583884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583884800000",
    "number": "1407481245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "344 E 100 S STE 301",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841111727",
            "telephone_number": "801-322-4257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "743 E 300 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84102",
            "telephone_number": "801-428-3500",
            "fax_number": "801-210-5031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ODYSSEY HOUSE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-11",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A",
        "authorized_official_last_name": "COHEN",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "801-428-3449"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Odyssey House Martindale Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.