Individual provider Active NPI

Richard J Odiam, LCSW

  • Clinical Social Worker
  • Kansas City, MO
National Provider Identifier
1689722373
Registry record updated Dec 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
005056 Issued in MO
Practice address
9233 Ward Pkwy
Suite 125
Kansas City, MO 64114-3366
Phone
(913) 327-4686
Fax
(816) 333-1776
NPI assigned
Jan 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 005056 MO Primary

Addresses

Primary practice location

9233 Ward Pkwy
Suite 125
Kansas City, MO 64114-3366

Mailing address

5827 Charlotte St
Kansas City, MO 64110-3017

Other identifiers 1

IdentifierTypeStateIssuer
495456105MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
005056MOMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419206400000",
    "number": "1689722373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5827 CHARLOTTE ST",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641103017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9233 WARD PKWY",
            "address_2": "SUITE 125",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641143366",
            "telephone_number": "913-327-4686",
            "fax_number": "816-333-1776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODIAM",
        "first_name": "RICHARD",
        "middle_name": "J",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2014-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "005056",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "495456105",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kansas City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2014; 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.