NPIMap

Individual provider Active NPI

Carol M Odegaard, M.D.

  • Family Medicine Physician
  • Jackson, GA
National Provider Identifier
1700876554
Registry record updated May 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
40495 Issued in GA
Practice address
261 Brookwood Ave
Jackson, GA 30233-1460
Phone
(678) 752-0555
Fax
(678) 752-0556
NPI assigned
Oct 24, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 40495 GA Primary

Addresses

Primary practice location

261 Brookwood Ave
Jackson, GA 30233-1460

Mailing address

261 Brookwood Ave
Jackson, GA 30233-1460
Phone (678) 752-0555

Other identifiers 4

IdentifierTypeStateIssuer
000752166SMedicaidGA
202I083605OtherGACMOMDPC IND MCARE #
P00708556OtherGARAILROAD MEDICARE
000752166UOtherGACMOMDPC IND MCAID #

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
I20090114000561 GA Practitioner - Family Practice 5799848982 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Mercer University School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Medical Care CorporationGroup PAC ID 6002802220, 368 clinicians

Practice addresses (Care Compare)

105 Collier Rd NW
Suite 5020
Atlanta, GA 30309-1731
Phone (404) 367-3210

2171 Lavista Rd NE
Suite 100
Atlanta, GA 30329-3915
Phone (404) 982-8009

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.62 of 100Reported as apm
Quality
83.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
40495GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Medical Care Corporation Family Medicine CurrentSince May 1, 2019 Accepting new patients
Piedmont Providers LLC Past Accepting new patients
Aylo Health, LLC Past Accepting new patients
The Doctor'S Office, LLC Family Medicine Past Accepting new patients
Aylo Health, LLC Family Medicine Past Accepting new patients
Aylo Health, LLC Family Medicine Past Accepting new patients
The Lighthouse Community Hospice Inc Family Medicine PastSince Mar 1, 2020 Accepting new patients
Aylo Health, LLC Family Medicine Past Accepting new patients

Locations

105 Collier Rd NW
Ste 5020
Atlanta, GA 30309
Phone (404) 350-3860

261 Brookwood Ave
Jackson, GA 30233
Phone (678) 752-0555

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 Lighthouse Community Hospice IncMcDonough, GA, CCN 851528 Hospice Contracted Managing Employee Mar 1, 2020

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 9

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.

Hospital & facility affiliations 5

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": "1130112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557187200000",
    "number": "1700876554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "261 BROOKWOOD AVE",
            "city": "JACKSON",
            "state": "GA",
            "postal_code": "302331460",
            "telephone_number": "678-752-0555",
            "fax_number": "678-752-0556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "261 BROOKWOOD AVE",
            "city": "JACKSON",
            "state": "GA",
            "postal_code": "302331460",
            "telephone_number": "678-752-0555",
            "fax_number": "678-752-0556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODEGAARD",
        "first_name": "CAROL",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-24",
        "last_updated": "2019-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "40495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000752166S",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMOMDPC IND MCARE #",
            "identifier": "202I083605",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00708556",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMOMDPC IND MCAID #",
            "identifier": "000752166U",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, GA

Sources for this page

Verify at the official NPI Registry.