Individual provider Active NPI

Ede V Odogbo

  • Family Nurse Practitioner
  • Houston, TX
National Provider Identifier
1619417813
Registry record updated Aug 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP132423 Issued in TX
Practice address
4700 W Sam Houston Pkwy N Ste 220
Houston, TX 77041-8224
Phone
(346) 209-3090
NPI assigned
Mar 7, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 22, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP132423 TX
Family Nurse Practitioner 363LF0000X AP132423 TX Primary

Addresses

Primary practice location

4700 W Sam Houston Pkwy N Ste 220
Houston, TX 77041-8224

Mailing address

4700 W Sam Houston Pkwy N Ste 220
Houston, TX 77041-8224
Phone (713) 402-7824

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20170803000646 TX Practitioner - Nurse Practitioner 8325319718 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellmed Medical Group PAGroup PAC ID 4880657386, 666 clinicians

Practice addresses (Care Compare)

San Antonio, TX 78257
Phone (210) 617-4706

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP132423TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wellmed Medical Group, PA CurrentSince Jul 28, 2024 Accepting new patients
Wellmed Medical Group, P.a. CurrentSince Jul 28, 2024 Accepting new patients

Locations

4700 W Sam Houston Pkwy N
Ste 220
Houston, TX 77041
Phone (713) 402-7824

4330 Medical Dr
Ste 500
San Antonio, TX 78229
Phone (210) 558-0122

8637 Fredericksburg Rd
Ste 360
San Antonio, TX 78240
Phone (210) 304-3500

6157 NW Loop 410
Ste 124
San Antonio, TX 78238
Phone (210) 523-1411

448 Castroville Rd
San Antonio, TX 78207
Phone (210) 434-1400

19500 Ih 10 W
#15030
San Antonio, TX 78257
Phone (210) 617-4607

Organizations & group practices 2

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": "1488844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724284800000",
    "number": "1619417813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 W SAM HOUSTON PKWY N STE 220",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770418224",
            "telephone_number": "713-402-7824",
            "fax_number": "713-570-0196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 W SAM HOUSTON PKWY N STE 220",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770418224",
            "telephone_number": "346-209-3090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODOGBO",
        "first_name": "EDE",
        "middle_name": "V",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-07",
        "last_updated": "2024-08-22",
        "certification_date": "2024-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP132423",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP132423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.