NPIMap

Individual provider Active NPI

Andrew William Odegaard, MD

  • Family Medicine Physician
  • Macon, GA
National Provider Identifier
1669095790
Registry record updated Aug 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
12178 Issued in GA
Practice address
3780 Eisenhower Pkwy
Macon, GA 31206-0800
Phone
(478) 633-5500
NPI assigned
May 23, 2020
Last updated
Aug 12, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Family Medicine Physician 207Q00000X 12178 GA Primary

Addresses

Primary practice location

3780 Eisenhower Pkwy
Macon, GA 31206-0800

Mailing address

3780 Eisenhower Pkwy
Macon, GA 31206-0800
Phone (478) 633-5500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230921003866 GA Practitioner - Family Practice 7810302056 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Mercer University School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jasper Health Services Inc.Group PAC ID 7214901230, 8 clinicians

Practice addresses (Care Compare)

898 College St
Monticello, GA 31064-1258
Phone (706) 468-0988

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Health Services of Central Georgia, Inc Family Medicine CurrentSince Aug 15, 2021 Accepting new patients
Jasper Health Services, Inc. Family Medicine CurrentSince Aug 3, 2023 Accepting new patients
Jasper Health Services Inc. CurrentSince Aug 3, 2023 Accepting new patients
The Medical Center of Central Georgia Inc PastSince Aug 15, 2021 Accepting new patients
Jasper Health Services Inc. Past Accepting new patients

Locations

898 College St
Monticello, GA 31064
Phone (706) 468-0988

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The RetreatMonticello, GA, CCN 115675 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2026
Jan 1, 2026

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1590192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628726400000",
    "number": "1669095790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3780 EISENHOWER PKWY",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312060800",
            "telephone_number": "478-633-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3780 EISENHOWER PKWY",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312060800",
            "telephone_number": "478-633-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODEGAARD",
        "first_name": "ANDREW",
        "middle_name": "WILLIAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-23",
        "last_updated": "2021-08-12",
        "certification_date": "2021-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "12178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.