Individual provider Active NPI

Elaine Odiase

  • Pediatric Gastroenterology Physician
  • Little Rock, AR
National Provider Identifier
1467871509
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
E-13483 Issued in AR
Practice address
1 Childrens Way # 517-7
Little Rock, AR 72202-3500
Phone
(501) 364-6711
Fax
(501) 364-6291
NPI assigned
Apr 15, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X E-13483 AR
Pediatric Gastroenterology Physician 2080P0206X E-13483 AR Primary

Addresses

Primary practice location

1 Childrens Way # 517-7
Little Rock, AR 72202-3500

Mailing address

1 Childrens Way # 653
Little Rock, AR 72202-3500
Phone (501) 364-1100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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
I20200904000057 AR Practitioner - Pediatric Medicine 2062839087 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
E-13483ARMDPediatric Gastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Arkansas for Medical Sciences CurrentSince Aug 1, 2020 Accepting new patients
Arkansas Childrens Hospital Pediatrics CurrentSince Aug 1, 2020 Accepting new patients
University of Arkansas for Medical Sciences CurrentSince Aug 1, 2020 Accepting new patients
Arkansas Children'S Hospital CurrentSince Aug 1, 2020 Accepting new patients
University of Arkansas for Medical Sciences Pediatrics Current Accepting new patients
University of Arkansas for Medical Sciences CurrentSince Aug 1, 2020 Accepting new patients
University of Arkansas for Medical Sciences Pediatrics Current Accepting new patients
Arthur M. Blank Hospital, Inc. Past Accepting new patients
Choa Multispecialty, LLC Pediatrics Past Accepting new patients

Locations

1 Childrens Way
#5177
Little Rock, AR 72202
Phone (501) 364-6711

1 Childrens Way
Little Rock, AR 72202
Phone (501) 364-1874

1 Childrens Way
#653
Little Rock, AR 72202
Phone (501) 614-2006

4301 W Markham St
Little Rock, AR 72205
Phone (501) 603-1278

Organizations & group practices 9

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": "1397520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1467871509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS WAY # 653",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722023500",
            "telephone_number": "501-364-1100",
            "fax_number": "501-364-4082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS WAY # 517-7",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722023500",
            "telephone_number": "501-364-6711",
            "fax_number": "501-364-6291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODIASE",
        "first_name": "ELAINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-15",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E-13483",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "AR",
            "license": "E-13483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.