Matthew Odishoo

Primary specialty

Adult CompanionTaxonomy code 372600000X

License

AL10626H Issued in AZ

Practice address

2114 S 118TH Ave
Avondale, AZ 85323-7643

Phone

(623) 792-7930

Fax

(623) 777-1683

NPI assigned

Jul 9, 2018

Last updated

Jul 9, 2018By the provider in NPPES

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Assisted Living of the Valley, LLC

  • Assisted Living Facility
  • Avondale, AZ
  • NPI 1225515281
  NPD (past) Authorized official

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

{
    "created_epoch": "1531094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531094400000",
    "number": "1679069025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2114 S 118TH AVE",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853237643",
            "telephone_number": "623-792-7930",
            "fax_number": "623-777-1683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2114 S 118TH AVE",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853237643",
            "telephone_number": "623-792-7930",
            "fax_number": "623-777-1683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODISHOO",
        "first_name": "MATTHEW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-09",
        "last_updated": "2018-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": "AZ",
            "license": "AL10626H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "381288",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Companion in Avondale, AZ
• Providers in Avondale, AZ by specialty
• Adult Companion in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.