NPIMap

Individual provider Active NPI

Kelly Nicole O'Dell, M.D.

  • Family Medicine Physician
  • Oakwood, GA
National Provider Identifier
1700226131
Registry record updated Aug 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
83884 Issued in GA
Practice address
4222 Fairbanks Dr
Oakwood, GA 30566-2811
Phone
(770) 534-6053
Fax
(770) 534-6050
NPI assigned
Jun 29, 2013
Last updated
Aug 8, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 125063367 IL
Family Medicine Physician 207Q00000X 036141396 IL
Family Medicine Physician 207Q00000X 83884 GA Primary

Addresses

Primary practice location

4222 Fairbanks Dr
Oakwood, GA 30566-2811

Mailing address

PO Box 658
Gainesville, GA 30503-0658
Phone (770) 718-1122

Other practice location 1

1818 E Windsor Rd
Urbana, IL 61802-9566
Phone (217) 255-9670

Other names 1

  • Kelly Mast Former name

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
I20200708003618 GA Practitioner - Family Practice 3274759451 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Longstreet Clinic, PCGroup PAC ID 2668465733, 140 clinicians
Northeast Georgia Community Physicians LLCGroup PAC ID 3274010582, 129 clinicians

Practice addresses (Care Compare)

4222 Fairbanks Dr
Oakwood, GA 30566-2811
Phone (770) 534-6053

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.1 of 100Reported as group
Quality
87.6
Promoting interoperability
100
Improvement activities
40
Cost
76.07

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125063367ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Longstreet Clinic PC CurrentSince Jun 1, 2020 Accepting new patients
The Longstreet Clinic, PC Family Medicine CurrentSince Jun 1, 2020 Accepting new patients
Northeast Georgia Community Physicians LLC CurrentSince Feb 3, 2026 Accepting new patients

Locations

725 Jesse Jewell Pkwy SE
Gainesville, GA 30501
Phone (770) 297-2200

4222 Fairbanks Dr
Oakwood, GA 30566
Phone (770) 534-6053

Organizations & group practices 3

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 7

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": "1372464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659916800000",
    "number": "1700226131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 658",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305030658",
            "telephone_number": "770-718-1122",
            "fax_number": "770-533-4786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4222 FAIRBANKS DR",
            "city": "OAKWOOD",
            "state": "GA",
            "postal_code": "305662811",
            "telephone_number": "770-534-6053",
            "fax_number": "770-534-6050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1818 E Windsor Rd",
            "address_purpose": "LOCATION",
            "city": "Urbana",
            "state": "IL",
            "postal_code": "618029566",
            "country_code": "US",
            "telephone_number": "217-255-9670",
            "fax_number": "217-255-9724",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "O'DELL",
        "first_name": "KELLY",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-29",
        "last_updated": "2022-08-08",
        "certification_date": "2022-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125063367",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036141396",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "83884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "MAST",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Oakwood, GA

Sources for this page

Verify at the official NPI Registry.