Mitchell Gray Odom, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AC001965 Issued in MD

Practice address

2001 Medical Pkwy
Annapolis, MD 21401-3773

Phone

(443) 481-1000

Fax

(443) 481-6515

NPI assigned

May 11, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

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 and National Provider Directory roles.

• Luminis Health Medical Group, LLC

  • Maternal & Fetal Medicine Physician
  • Annapolis, MD
  • NPI 1073580205
  Medicare reassignment NPD
• Luminis Health Medical Group, LLC

  • Family Medicine Physician
  • Pasadena, MD
  • NPI 1063837490
  NPD
• Luminis Health Medical Group, LLC

  • Internal Medicine Physician
  • Bowie, MD
  • NPI 1720835010
  NPD

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

{
    "created_epoch": "1242000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489017600000",
    "number": "1699909283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 MEDICAL PKWY",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214013773",
            "telephone_number": "443-481-1000",
            "fax_number": "443-481-6515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 MEDICAL PKWY",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214013773",
            "telephone_number": "443-481-1000",
            "fax_number": "443-481-6515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODOM",
        "first_name": "MITCHELL",
        "middle_name": "GRAY",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-11",
        "last_updated": "2017-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5004355",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "AC001965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suzanne Ochs, PA
• Lindsay Arna Oconnor, OTR/L
• Deborah Odell, DDS
• George J. Odell, M.D.
• Joseph Alfred Odierno, DO
• Emmalene Offerman
• Samantha Christine Offutt, OTR/L
• Ifeoma Maureen Ogamba-Alphonso
• Adeleke A. Ogunmefun, M.D.
• Melanie Lynn Ogunmefun, M.D.

• Psychiatric/Mental Health Nurse Practitioner in Annapolis, MD
• Providers in Annapolis, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2017; 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.