Wallace Paul Odom, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

1-071049 Issued in AL

Practice address

911 Big Cove Rd SE
Huntsville, AL 35801-3750

Phone

(256) 265-8120

Fax

(256) 265-8969

NPI assigned

Feb 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 1975

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Huntsville Hospital AnesthesiaGroup PAC ID 7315990751, 157 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Huntsville Hospital Hospital, Huntsville, AL, CCN 010039

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

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.

• Huntsville Hospital Anesthesia

  • Certified Registered Nurse Anesthetist
  • Huntsville, AL
  • NPI 1851321079

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• The Health Care Authority of the City of Huntsville

  • Psychiatry Physician
  • Huntsville, AL
  • NPI 1760400535
  NPD (past)
• Jackson Clinic PA

  • Internal Medicine Physician
  • Jackson, TN
  • NPI 1285629386
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• The Health Care Authority of the City of Huntsville

  • General Acute Care Hospital
  • Huntsville, AL
  • NPI 1447221056
  Care Compare affiliation

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

{
    "created_epoch": "1140048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228348800000",
    "number": "1508830308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1389",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358070389",
            "telephone_number": "205-979-5882",
            "fax_number": "205-979-1248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 BIG COVE RD SE",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358013750",
            "telephone_number": "256-265-8120",
            "fax_number": "256-265-8969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODOM",
        "first_name": "WALLACE",
        "middle_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-16",
        "last_updated": "2008-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AL",
            "license": "1-071049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051526353",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS #",
            "identifier": "51526353",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE #",
            "identifier": "P00216451",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Oakwoods Dream Care Assisted Living Facility LLC.
• OB/GYN Sub-Speciality Center,PC
• Michael Anthony Oddo, PHARMD
• Lindsey Odinma, MSW
• Olaoluwa Mary Odofin, M.D
• Kathryn Odonoghue
• Odyssey Healthcare Operating B LP
• Office Eye Surgery LLC
• Justina Rae Officer, RN
• Kyah Daja Ogburn

• Certified Registered Nurse Anesthetist in Huntsville, AL
• Providers in Huntsville, AL by specialty
• Certified Registered Nurse Anesthetist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2008; 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.