Carly M Odesina, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

12.006642 Issued in CT

Practice address

270 Main St
Portland, CT 06480-1836

Phone

(860) 342-3392

Fax

(860) 358-8658

NPI assigned

Jun 16, 2016

Last updated

Sep 14, 2018By the provider in NPPES

Sex

Female

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 1

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hartford Healthcare Medical Group, Inc

  dba Hartford HealthCare Medical Group

  • Surgery Physician
  • Wethersfield, CT
  • NPI 1043561301
  Medicare reassignment NPD
• Hartford Healthcare Urgent Care Centers, LLC

  • Urgent Care Clinic/Center
  • Avon, CT
  • NPI 1093239683
  Medicare reassignment NPD
• University of Connecticut Student Health and Wellness

  • Student Health Clinic/Center
  • Storrs Mansfield, CT
  • NPI 1629097043
  NPD (past)

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

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536883200000",
    "number": "1548610959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 CRESCENT ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573654",
            "telephone_number": "860-358-4820",
            "fax_number": "860-358-8661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 MAIN ST",
            "city": "PORTLAND",
            "state": "CT",
            "postal_code": "064801836",
            "telephone_number": "860-342-3392",
            "fax_number": "860-358-8658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODESINA",
        "first_name": "CARLY",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-16",
        "last_updated": "2018-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "12.006642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008067661",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Brian Morse, DDS
• Kelly Marie Mullen, PT, DPT
• Louis R Neumann, O.D.
• Matthew Nichols
• Sara Oconnell, MA, CCC-SLP
• Jennifer Owens, LAT, ATC
• Rupesh Pandey, DDS
• Stephen P Paschall, LPC
• Vipul Anant Patel, DMD
• Michelle M Pellin, LPC

• Family Nurse Practitioner in Portland, CT
• Providers in Portland, CT by specialty
• Family Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.